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在ABO不兼容的活体捐赠者移植后,早期的血栓性微血管病变

Dominique Bertrand¹, Arnaud Del Bello², Rebecca Sberro Soussan³

¹Department of Nephrology, Kidney Transplantation and Hemodialysis, Rouen University Hospital, Rouen, France.

Kidney international reports

|April 14, 2025

概括

血栓式微血管病变 (TMA) 发生在6.1%的ABOi移植中,通常是早期的,并与不良结果相关. 更高的移植前抗体水平预测TMA,但血凝位是不完美的标记.

科学领域:

腎臟病學 (nephrology) 是一種醫學專業.
移植免疫学移植免疫学
血管生物学血管生物学

背景情况:

ABO不兼容 (ABOi) 移植为血型不兼容的患者提供了替代方案.
虽然长期的移植存活率与ABO兼容 (ABOc) 移植相当,但ABOi移植具有更高的抗体中介排斥 (ABMR) 风险.
早期的血栓性微血管病变 (TMA) 是ABOi移植的一个重要并发症.

研究的目的:

研究在接受ABOi脏移植的患者中TMA的发生率,临床表现和结果.
为了确定ABOi脏移植后TMA发育的预测因素.
为了评估TMA治疗在这个人群中的有效性.

主要方法:

追溯多中心研究.
包括在ABOi移植后一个月内经过活检证明或生物确认的TMA患者.
与具有良好的初始结果和正常活检的匹配对照进行比较.

主要成果:

在375例ABOi移植中,TMA发生在6.1%的患者中,中位数发生在移植后1天.
在80.9%的早期移植活检中发现了活性TMA的组织学证据.
发生了8个早期移植损失 (30.4%);在移植前,较高的IgG和IgM抗血组抗体 (ABGA) 水平预测了TMA.
治疗包括等离子体和eculizumab,但对没有反应的人来说,预后不佳.

结论:

TMA是ABOi移植的重大并发症,发生在早期,并与预后不佳有关.
移植前的IgG和IgM ABGA水平可以预测TMA,但血液凝结试验是不完美的标志物.
需要进一步的研究来改善TMA预测和管理在ABOi移植.

关键词:

不符合ABO的不兼容.通过抗体介导的排斥.在此之前,Eculizumab也曾被使用过.移植脏移植移植脏血栓性微血管病变 - - 血栓性微血管病变

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