在使用治疗性血交换的不兼容移植中,ABO抗体滴定动力学和优化
Anubha Srivastava1, Priti Elhence2, Bharat Singh2
1Transfusion Medicine, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND.
Cureus
|August 28, 2025
概括
在移植患者中,高基线抗ABOIgG标位需要更多的移植前治疗性血交换 (TPE). 然而,这并没有增加移植后的TPE,表明TPE方案对ABO不兼容的移植有效.
科学领域:
- 肝脏病学
- 免疫学
- 移植
背景情况:
- 抗ABO不兼容的移植 (ABOi KT) 可以扩大器官的获取,但需要管理抗ABO单聚氨酸以防止抗体介导排斥 (ABMR).
- 预先存在的抗体标位显著影响脱敏方案和移植结果.
研究的目的:
- 需要在移植前和移植后对抗ABO IgG基线 (≥64和<64) 和治疗性血交换 (TPE) 强度之间的相关性进行研究.
- 在资源有限的环境中评估ABMR发生率,移植功能,患者和移植存活率以及与TPE相关的不良事件.
主要方法:
- 一个前性单中心研究,涉及20名基于TPE的标准化脱敏方案的ABOi KT接受者.
- 患者接受了基于TACROLIMUS的免疫抑制,TPE,IVIG,Rituximab和ATG,并进行了序列 ABO IgG和IgM标位监测.
- 通过高 (≥64) 与低 (<64) 基线IgG标位分层.
主要成果:
- 具有高基线IgG标位的接受者需要显著更多的移植前TPE疗程 (平均值为5. 2对3. 4; p=0. 02).
- 移植后的TPE需求在不同组之间是相似的.
- 在45%的患者中发生了ABMR,在高滴度组中发生率趋势较高 (不具有统计意义).
- 在24个月后观察到稳定的移植功能,高患者存活率和罕见的轻度TPE相关不良事件.
结论:
- 基线IgG标位升高需要强化移植前脱敏,但不需要增加移植后的TPE.
- 在资源有限的环境中,以TPE为中心的标准化协议对ABOi KT来说是安全有效的.
- 适应风险的策略和实时免疫监测对于优化ABOi KT结果至关重要.
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