关键词:

ABO 血型不相容肾移植 , 血浆置换 , 利妥昔单抗 , 术后感染

Abstract:

Objective There is a huge gap between organ demand and supply for patients with end-stagerenal disease. To increase the supply of kidneys，kidney transplantation is trying to break through ABO and human leukocyte antigen （HLA） incompatible barriers. ABO-incompatible kidney transplantation （ABOi-KT） increases the risk of antibody-mediated rejection, infection and death in recipients. We use plasma exchange and rituximab desensitization therapy before surgery in ABOi-KT recipients to reduce the incidence of rejection and improve graft and patient survival. Methods All recipients undergoing ABOi kidney transplantation in our center from 2020 to 2023 were included. Recipients underwent rituximab and plasma exchange therapy preoperatively, and ABO antibody titers were measured after each plasma exchange. Intravenous methylprednisolone was administered as induction therapy before transplantation. Oral prednisone，mycophenolate and tacrolimus were used as maintenance therapy. Results A total of6 cases of ABOi-KT were performed with an average follow-up of 412 days. One patient suffered from Klebsiella pneumoniae and Candida glabrata infection, and was cured after anti-bacterial and anti-fungal treatment. None of the 6 patients suffered from BK virus，cytomegalovirus，or herpes simplex virus infection. One patient had post-operative urine leakage from the graft kidney and underwent re-anastomosis of the transplanted ureter and bladder. The 1-year graft and patient survival rates were all 100%. Conclusion In our center's ABOi-KT，the risk of infectious complications was low，and graft and patient survival were good. 

Key words:

ABO-incompatible kidney transplantation,  , Plasma exchange,  , Rituximab,  , Postoperative infection