汎血球減少を来し治療に難渋した血液型不適合生体腎移植の1例

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In ABO incompatible kidney transplantation (KTx), anti-donor blood type antibody titers (ADBT) should be reduced preoperatively with plasma exchange (PE) preoperatively to avoid hyperacute rejection. Despite several sessions of PE, some recipients do not respond to the treatment, and in whom the antibody titers do not decrease enough. We have developed a new protocol using an anti-CD20 monoclonal antibody (rituximab) for patients who do not respond to previous treatment. The protocol consists of 2 or 3 infusions of rituximab at a dose of 375 mg/m^2 weekly for 3 weeks, laparoscopic splenectomy 1 week before KTx, and 3 or 4 sessions of PE after splenectomy. The immunosuppressive regimens were initiated with an anti IL-2 receptor monoclonal antibody, basiliximab, followed by cyclosporine, mycophenolate mofetil, and methylprednisolone. Seven patients were involved in the new protocol. In all cases, the ADBT dropped to below 1:16, and KTx could be performed as scheduled. No significant side effects associated with rituximab infusions were encountered except for one female patient, who developed pancytopenia after the preconditioning. Eventually her blood cell counts recovered to normal, and she could complete the transplant. At a mean follow-up time of 679.9 days, all renal allografts are functioning well. Although pancytopenia associated with rituximab infusion should be considered as a serious complication, this new preconditioning regimen enables patients with high level ADBTs to undergo ABO-incompatibleKTx, and may extend the indications and improve the long-term outcome of KTx.
東京女子医科大学の論文

汎血球減少を来し治療に難渋した血液型不適合生体腎移植の1例

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