二重濾過血漿分離交換法を行ったABO血液型不適合生体腎移植の1例

Abstract

44歳男.ABO血液型不適合生体腎移植の1例を経験した.低蛋白, 低アルブミン血症に留意すれば, ABO血液型不適合生体腎移植術前処置としての二重濾過血漿分離交換法(DEPP)による赤血球抗体の除去は有用であると思われた

A 40-year-old female, whose blood type was A, Rh+, was admitted to our hospital for kidney transplantation from her younger brother whose blood type was B, Rh+. Before the transplantation, we performed 4 sessions of double filtration plasmapheresis (DFPP) to remove the anti-B antibodies. The serum anti-B antibody titer lowered from X32 to X4. The kidney transplantation was carried out following the splenectomy. The warm ischemic time was 8 minutes and the cold ischemic time was 47 minutes. Five immuno-suppressive agents including cyclospolin, azathioprine, prednisolone, anti-lymphocyte globulin (ALG), and deoxyspergualin were administered in the initial period. Nine days after the transplantation, an acute rejection occurred, and 15 sessions of hemodialysis were needed. However, Methylprednisolone and OKT3 treatment resulted in recovery of the graft function. Seventy-four days after the transplantation, she was discharged with the serum creatinine concentration of 1.3 mg/dl. The DFPP before transplantation was useful to remove the anti-RBC antibody from the patient receiving an ABO incompatible kidney allograft.