■随着免疫抑制方案的改进,ABO血型不合(ABO-i)肾移植(KT)的成功率和可获得性逐渐增加.然而,与ABO-iKT相关的免疫抑制方案和并发症的管理是复杂的.这里,我们报道了一例ABO-i活体供者KT的临床病例,其同种异体移植功能障碍是由人细小病毒B19(B19V)引发的急性血型抗体依赖性排斥反应引起的.
■受者的ABO血型为O,供体是B。受体具有较高的基线抗B抗体滴度(IgM,1:1024;IgG,1:64)。移植前,他完成了包括血浆置换在内的脱敏方案,双重过滤血浆置换,利妥昔单抗,维持低血型抗体水平,并导致成功的移植。手术两周后,受者出现B19V感染并伴有急性T细胞介导的排斥反应.在抗排斥方案之后,急性排斥反应(AR)被成功逆转,但是B19V坚持了下来。AR稳定一周后,患者经历了更严重和难治的急性抗体介导的排斥反应,导致移植肾的损失.
■脱敏联合免疫抑制剂可导致过度免疫抑制并引起各种感染。感染可能会破坏患者的适应状态,从而诱导AR并导致移植肾的损失。
UNASSIGNED: With the improvement of immunosuppressive regimens, the success rate and availability of ABO-incompatible (ABO-i) kidney transplantation (KT) have gradually increased. However, the management of immunosuppression protocols and complications associated with ABO-i KT is complex. Here, we report a clinical case of ABO-i living donor KT with allograft dysfunction caused by acute blood group antibody-dependent rejection triggered by human parvovirus B19 (B19V).
UNASSIGNED: The ABO blood group of the recipient was O, and that of the donor was B. The recipient had high baseline anti-B antibody titers (IgM, 1:1024; IgG, 1:64). Before transplantation, he completed a desensitization protocol comprising plasma exchange, double-filtration plasmapheresis, and rituximab, which maintained a low blood group antibody level and resulted in successful transplantation. Two weeks after surgery, the recipient developed a B19V infection combined with acute T-cell-mediated rejection. After the anti-rejection regimen, acute rejection (AR) was successfully reversed, but B19V persisted. One week after AR stabilization, the patient experienced acute antibody-mediated rejection that was more severe and refractory, resulting in the loss of the transplanted kidney.
UNASSIGNED: Desensitization combined with immunosuppressants can lead to overimmunosuppression and cause various infections. Infections could break the accommodation state of the patient, thereby inducing AR and resulting in the loss of the transplanted kidney.