ABO血型不合异基因造血干细胞移植对红系造血恢复的影响

本研究探讨ABO血型不合异基因造血干细胞移植对红系造血的影响。对16例ABO血型不合的造血干移植患者的ABO血型,IgM和IgG抗体进行监测。结果显示,16例ABO血型不合的造血干细胞移植患者均恢复造血功能,与ABO血型相合组比较,ABO血型不合组在粒细胞植活时间、血小板植活时间无差异,但红系重建时间明显延长;ABO主侧不合与双侧不合受者抗供者凝集素消失时间与红系恢复时间有相关性。结论 :ABO血型不合的异基因造血干细胞移植会导致红系造血迟缓。移植前用供型血浆置换法或输注供者红细胞来中和受者体内抗供者红细胞的凝集素能缩短红细胞植入时间,减少红细胞的输注。     

血浆置换预防ABO血型不合骨髓输注溶血反应的临床观察与护理

目的 应用血浆置换预防ABO血型主要不合骨髓移植时骨髓输注溶血反应的效果观察及护理对策。方法 采用血浆置换去除受体内凝集素的方法预防2例ABO血型主要不合骨髓移植急性溶血反应。结果 血浆置换后，2例患抗体滴度(IgM、IgG)均l：16，输注血型主要不合骨髓时均未发生急性溶血反应，亦未出现迟发性溶血反应；2例患均移植成功。结论 血浆置换可有效预防ABO血型主要不合骨髓移植时溶血反应的发生，护士进行全面术前准备、术中监护及术后临床观察，采取及时、必要的护理措施，有效降低了相关并发症，确保了疗效。     

ABO血型不相容肾移植行血浆双滤置换的护理

总结10例患者于ABO血型不相容活体肾移植术前接受血浆双滤置换的护理经验。护理要点包括做好血浆双滤置换前准备,加强血浆置换专用机器压力指标的监测,做好并发症的观察及处理。经过治疗与护理,10例患者无一例发生急性排斥反应,康复出院。     

两种血细胞分离机在跨血型肾移植中降低血型抗体滴度的效果比较

目的对比分析两种血细胞分离机在跨血型肾移植中降低血型抗体滴度方面的效果。方法利用CS-3000和COM.TEC血细胞分离机对2015年1月～2017年11月23例ABO血型不合肾移植受者行血浆置换治疗。结果使血型抗体滴度下降1倍,CS-3000组需置换出(1.3±0.5)个血浆容量,而COM.TEC组需置换出(0.9±0.2)个血浆容量。CS-3000组处理1个血浆容量所需时间为(95.2±10.4)min,COM.TEC组处理1个血浆容量所需时间为(75.0±11.2)min(P0.001)。CS-3000组血浆去除效率为(39.7±4.9)%,而COM.TEC组血浆去除效率为(48.2±3.7)%(P0.001)。与血浆置换前的血液成分相比,CS-3000组置换后患者血小板明显下降,平均下降25.42%,而COM.TEC组置换后患者血小板下降率为12.56%。结论与CS-3000血细胞分离机比较,COM.TEC血细胞分离机治疗性血浆置换有更高的血浆去除效率,处理1个全血浆容量所需时间更短,并且损失的血小板更少。相比之下COM.TEC比CS-3000血细胞分离机更适用于初始抗血型抗体效价较高且血小板较低的肾移植受者。     

4例ABO血型不相容肝移植血型抗体效价监测分析

目的密切监测4例ABO血型不相容肝移植术前术后血型抗体效价,防治抗体介导的排斥反应发生,提高移植成活率。方法应用经典试管盐水稀释法检测4例ABO血型不相容肝移植患者术前、术后1d,术后1周、2周、3周、1月、2月、3月抗-A、抗-B、抗-AB效价值。结果 4例ABO血型不相容肝移植患者术前-抗A、抗-B、抗-AB效价分别为0、64、64; 64、64、64; 128、256、128; 64、128、64,术后1 d都急剧下降,分别在1—3周回升到峰值,免疫抑制治疗后,又逐渐下降。结论 ABO血型不相容肝移植术前术后抗体效价监测极具临床意义,是移植医生采取抑制体液免疫反应措施的必要依据。     

淋巴血浆置换术在ABO血型不相容亲属活体肾移植中的应用

目的探讨淋巴血浆置换术(Lymphoplasmapheresis,LPE)对ABO血型不相容亲属活体肾移植(ABO-incompatible kidney transplantation,ABOi-KT)患者的疗效。方法 8例ABOi-KT患者手术前共接受LPE治疗57次,比较LPE治疗前后血细胞计数、血浆蛋白含量差异;监测患者围手术期血型抗体效价变化;分析不良反应发生情况。结果患者LPE治疗前后比较,白细胞计数、中性粒细胞计数、血红蛋白、红细胞计数无明显变化(P0.05),治疗后淋巴细胞计数和血小板计数较治疗前明显下降,差异有统计学意义(P0.05);LPE治疗前后血浆总蛋白、白蛋白相比较无明显变化(P 0.05),治疗后球蛋白较治疗前含量明显下降,差异有统计学意义(P0.05);每例患者经数次LPE治疗,保证ABOi-KT手术当天血型抗体效价≤1∶16,且术后2周效价无反弹;LPE治疗中不良反应发生率为8.8%。结论 ABOi-KT患者术前应用LPE治疗,有助于手术更安全、有效的实施。     

血浆置换对高致敏肾移植受者的作用效应

2002年1月至2003年3月,我科共为14例高致敏受者行同种异体肾移植手术,除严格按照人类白细胞抗原(HLA)配型选择供受者外,术前均采用血浆置换取得了满意的移植效果。现报告如下。 一、临床资料 1.一般资料 14例高致敏受者均为首次行尸肾移植,供受者ABO血型相同,原发病均为慢性肾小球肾炎、合并肾功能衰竭(尿毒症期)。其中男性     

一例血型不符亲属活体肾移植患者围手术期的护理

<正>同种异体肾移植术是治疗各种终末期肾病的有效方法。在潜在的活体供者中,大约有30%的供者与受者AB0血型不相容,即供者血型和受者血型不符合输血原则。而国内的数据也高达25%以上[2]。在ABO血型不相容的活体肾移植中,如果术前不采取任何预处理措施,受者血清中的抗A或抗B血型的天然抗体与移植肾血管内皮细胞结合,引起抗体介导的急性排斥反应,如发烧、肌酐指标升高、尿少、B超显示血流不好     

ABO主侧不相容的骨髓移植患者输注供者型别的红细胞作为单独预备性治疗

同种骨髓移植对许多血液及非血液性疾病已是一种成熟的治疗方法。然而由于HLA基因复合体与ABO抗原在遗传上是相互独立的,因此受者与供者即使HLA相匹配,也可能ABO血型不相容。在这种情况下,要么去除受者的ABO抗体或者移植骨髓中的红细胞以防止在移植过程中发生严重的溶血反应。有两种方法可以减少患者的ABO抗体:一是血浆置换术,二是输注供者型别的红细胞。而血浆置换术费时,不仅去除ABO抗体,同时也把许多重要的抗体去除了,这样,会增加患者由于输注新鲜—冰冻血浆而造成感染的危     

ABO血型检查与抗体效价关系的探讨

目的：探讨ABO血型不合与抗体效价的关系。方法：用巯基乙醇破坏孕妇血清中的IgM血型抗体后，将血清倍比稀释，加入用菠萝酶处理过的指示红细胞，于抗人球蛋白血清介质中测定血清的IgG血型抗体效价。结果：288对ABO血型不合的夫妇中有142例孕妇的抗体效价≥64，以夫妇血型为A—O及B—O的人群中的孕妇居多。结论：降低孕妇体内的IgG血型抗体效价，对胎儿起到保护作用，以防止新生儿ABO溶血病的发生，对优育优生具有积极的意义。     

The critical role of plasmapheresis in ABO-incompatible renal transplantation

BACKGROUND: Thousands of patients with chronic renal failure die yearly and are unable to have a kidney transplant due to the severe shortage of donors. Therapeutic plasma exchange (TPE) is performed to remove ABO antibodies and permit ABO‐incompatible (ABO‐I) kidney transplants, but there is only limited research within this area and a lack of standardized protocols for TPE. This article reviews the literature to provide a historical perspective of TPE for ABO‐I kidney transplantation and also provides the Johns Hopkins Hospital protocol with a focus on both titers and TPE. STUDY DESIGN AND METHODS: The TPE treatment plan is based on ABO titers with the goal of a titer of 16 or less at the anti‐human globulin (AHG) phase before surgery. Pretransplant therapy consists of every‐other‐day TPE followed immediately by cytomegalovirus hyperimmune globulin. ABO antibody titers are closely monitored before and after transplantation. After transplantation, TPE therapy is performed for all patients to prevent rebound of anti‐A and anti‐B titers until tolerance or accommodation occurs. TPE is discontinued and reinstituted based on the clinical criteria of creatinine levels, biopsy results, and ABO titer. RESULTS: Fifty‐three ABO‐I kidney transplants have been completed with no episodes of hyperacute antibody‐mediated rejection (AMR) and only three episodes of AMR. One‐year death‐censored graft survival is 100 percent and patient survival is 97.6 percent. CONCLUSIONS: While randomized clinical trials are needed to evaluate the optimal method and protocol to remove ABO antibodies, the current literature and our results indicate a critical role for TPE in ABO‐I renal transplantation.     

正常O型人血清ABO血型抗体主要类别的分析

目的通过检测O型及A/B型人血清中IgM类及IgG类抗体的效价,分析正常O型人血清中ABO血型抗体的主要类别。方法分别以盐水介质法和间接抗人球蛋白法检测O型及A/B型人血清中IgM类和IgG类抗A或抗B抗体的效价。结果 O型人血清中IgM类抗A/抗B抗体效价均显著高于IgG类抗A/抗B抗体（均P〈0.01）;O型人血清中IgM类抗A/抗B抗体效价与B/A型人比较无显著性差异（均P〉0.05）,而IgG类抗A/抗B抗体效价显著高于B/A型人（均P〈0.01）;O型人血清中IgG类与IgM类抗A/抗B抗体效价的比值均显著高于B/A型人（均P〈0.01）。结论 O型人ABO血型抗体仍以IgM类为主,但其IgG类抗体效价及在血清中所占的比例要明显高于A/B型人。     

ABO‐incompatible living donor kidney transplantation without post‐transplant therapeutic plasma exchange

Blood group incompatibility remains a significant barrier to kidney transplantation. Approximately, one‐third of donors are blood group incompatible with their intended recipient. Options for these donor‐recipient pairs include blood group incompatible transplantation or kidney paired donation. However, the optimal protocol for blood group incompatible transplantation is unknown. Protocols differ in techniques to remove ABO antibodies, titer targets, and immunosuppression regimens. In addition, the mechanisms of graft accommodation to blood group antigens remain poorly understood. We describe a blood group incompatible protocol using pretransplant therapeutic plasma exchange (TPE), high‐dose intravenous immunoglobulin, and rituximab in addition to prednisone, mycophenolate mofetil, and tacrolimus. In this protocol, we do not exclude patients based on a high initial titer and do not implement post‐transplant TPE. All 16 patients who underwent this protocol received a living donor transplant with 100% patient and graft survival, and no reported episodes of antibody‐mediated rejection to date with a median follow‐up of 2.6 years (range 0.75–4.7 years). We conclude that blood group incompatible transplantation can be achieved without post‐transplant TPE. J. Clin. Apheresis 30:340–346, 2015. © 2015 Wiley Periodicals, Inc.     

Therapeutic plasma exchange reduces ABO titers to permit ABO-incompatible renal transplantation

BACKGROUND: Thousands of patients with chronic renal failure die yearly without a kidney transplant due to the severe shortage of donors. Therapeutic plasma exchange (TPE) is performed to permit ABO-incompatible (ABO-I) kidney transplants, but little is known about how well TPE reduces ABO antibodies or complications related to TPE in this clinical setting.
STUDY DESIGN AND METHODS: This retrospective study evaluated 46 individuals that received TPE to permit ABO-I kidney transplant. The number of TPE treatments was based on a goal ABO titer at the anti-human globulin (AHG) phase of 16 or less before surgery.
RESULTS: Before TPE, the median titer of recipient was 32 (range, 2-128) at room temperature (RT) phase and 64 (range, 4-1024) at AHG phase. The first TPE reduced the total agglutination reactivity score at AHG phase by 10.2 percent. Before transplantation, there was a mean of 6.2 ± 2.5 TPE treatments and total agglutination reactivity score at AHG phase was reduced by 53.5 percent. The median titer remained reduced at 3 to 6 months after transplantation at 4 (range, 0-64) at RT phase and 8 (range, 1-64) at AHG phase. TPE complications were minimal. During at least one procedure, 15 (32.6%) individuals had either urticaria or pruritis, 18 (39.1%) individuals experienced mild citrate-induced hypocalcemia, 5 (10.2%) individuals had hypotension, 6 (13.0%) individuals had nausea or vomiting, and 1 (2.2%) individual had West Nile virus encephalitis.
CONCLUSIONS: With current infectious disease blood screening protocols, TPE has minimal complications and can reduce ABO antibody titers to permit ABO-I renal transplantation.     

Apheresis therapy for living-donor liver transplantation: experience for apheresis use for living-donor liver transplantation at Kyoto University.

Liver transplantation is a fundamental treatment for patients with end-stage hepatic failure. In order to perform living-donor liver transplantations under safer conditions, apheresis plays a major role in Japan due to the prevalence of living-donor liver transplantation wherein later retransplantation is difficult. In our department, the roles of apheresis in liver transplantation are as follows: as bridge therapy to liver transplantation (n = 45); as a supplement to the graft liver until the recovery of hepatic function (n = 77); as treatment for multiple organ failure including posttransplantation renal failure (n = 15); and as a means with which to reduce antibody titers for antibodies such as anti-A or anti-B in persons with ABO blood type = incompatible liver transplantation (n = 23). In our department, we have performed 822 liver transplantations at present. Of those cases, 183 were selected wherein apheresis was performed around the time of the operation. In all cases, transplantation with sufficient apheresis was performed before the surgical operation, however, 22 patients (48.9%) died after undergoing surgery. Among the patients who underwent the postoperative apheresis, those in the nonsurvivor group had lower grafted liver weights compared to those of the survivor group. The kidney was the organ that most frequently failed due to postoperative complications. In cases of ABO blood type-incompatible liver transplantations, patients with high preoperative anti-A/B IgM antibody titers sustained bile duct complications, patients with high preoperative anti-IgG antibody titers sustained hepatic necrosis, and patients with high postoperative anti-A/B IgM and anti-IgG antibody titers sustained hepatic necrosis most frequently.     

微柱凝胶法检测ABO疑难血型的临床应用

目的 探讨微柱凝胶法(MGT)检测ABO疑难血型的敏感性及影响因素.方法 应用(MGT)法检测38 600例患者的ABO血型,同时用试管法进行复查对照,对正反定结果不一致的血标本,增加离心或37℃孵育时间去除血清中的纤维蛋白和冷凝集素,对血型抗原明显减弱或抗体效价降低者,采用增加定型血清或被检血清的剂量,预先将抗原抗体混合置37℃反应15-30 min,然后采用(MGT)法检测.结果 MGT法检测ABO血型抗原明显减弱或抗体效价降低者的敏感性高于试管法.MGT法检测ABO血型,对正反定结果不一致者35例,其中患者血浆含纤维蛋白9例、血清蛋白异常增高4例、高效价冷凝集素5例、血型抗原明显减弱8例、抗体效价降低9例.结论 纤维蛋白、高效价冷凝集素、血型抗原减弱或抗体效价降低均可干扰ABO血型鉴定结果.增加离心或37℃孵育时间去除定型血清或患者血浆剂量血清中的纤维蛋白和冷凝集素,增加定型血清或患者血浆的剂量,预先将抗原抗体混合置37℃反应15-30分钟,然后采用MGT法检测,可提高ABO血型鉴定的准确性和输血安全.     

血型IgG抗体效价联合脐血溶血3项在新生儿ABO溶血病早期诊断中的应用

目的探讨血型免疫球蛋白G(IgG)抗体效价与脐血溶血3项联合应用于新生儿ABO溶血病(ABOHDN)早期诊断中的效能。方法回顾性分析2016年3月至2018年6月深圳市龙华区人民医院收治的定期产检并正常分娩的O型血孕妇160例的临床资料,且与丈夫ABO血型均不合。分别对母血进行血型IgG抗体效价检测、对脐血进行溶血3项检测。以新生儿静脉血溶血3项及临床表现为诊断依据,判断ABO-HDN的发生情况。对比ABO-HDN发生者和未发生者母血血型IgG抗体效价检测结果、脐血溶血3项检测结果,分析不同方法对新生儿溶血病早期诊断的价值探讨。结果 160例受试者中共有75例发生ABO-HDN,发生率为46.88%;ABO-HDN发生者和未发生者血型IgG抗体效价检测结果分布对比差异有统计学意义(P <0.05),且前者≥1∶64者构成比明显高于后者,差异有统计学意义(P <0.05);ABO-HDN发生者脐血溶血3项阳性率均高于未发生者,差异有统计学意义(P <0.05),且ABOHDN发生者诊断阳性率高于高于未发生者,差异有统计学意义(P <0.05)。血型IgG抗体效价联合脐血溶血3项诊断早期ABO-HDN的特异度、准确度、阳性预测值和正确指数分别为97.65%、93.13%、97.06%、0.8565,均高于单独诊断,且灵敏度与血型IgG抗体效价相同,阴性预测值高于血型IgG抗体效价。结论 ABO-HDN在夫妻血型不合中的患病率高,将母体外周血血型IgG抗体效价与脐血溶血3项联合应用的诊断效能较高,有助于早期诊断。     

微柱凝胶法检测ABO疑难血型的临床应用及方法学探讨

目的探讨微柱凝胶法（MGT）检测ABO疑难血型的敏感性及影响因素。方法应用（MGT）法检测38600例患者的ABO血型,同时用试管法进行复查对照,对正反定结果不一致的血标本,增加离心或37~C孵育时间去除血清中的纤维蛋白和冷凝集素,对血型抗原明显减弱或抗体效价降低者,采用增加定型血清或被检血清的剂量,预先将抗原抗体混合置37℃反应15—30min,然后采用（MGT）法检测。结果MGT法检测ABO血型抗原明显减弱或抗体效价降低者的敏感性高于试管法。MGT法检测ABO血型,对正反定结果不一致者35例,其中患者血浆含纤维蛋白9例、血清蛋白异常增高4例、高效价冷凝集素5例、血型抗原明显减弱8例、抗体效价降低9例。结论纤维蛋白、高效价冷凝集素、血型抗原减弱或抗体效价降低均可干扰ABO血型鉴定结果。增加离心或37℃孵育时间去除定型血清或患者血浆剂量血清中的纤维蛋白和冷凝集素,增加定型血清或患者血浆的剂量,预先将抗原抗体混合置37℃反应15—30分钟,然后采用MGT法检测,可提高ABO血型鉴定的准确性和输血安全。     

ABO-incompatible kidney transplantation using regenerative selective immunoglobulin adsorption

Background: ABO‐incompatible (ABOi) kidney transplantation is an established procedure relying on the removal of donor‐specific isoagglutinine antibodies as part of the recipient preconditioning. At present, current protocols using immunoadsorption apply a single‐use selective carbohydrate isoagglutinine adsorber. A regenerative and selective immunoglobulin immunoadsorption could be an alternative but has not been reported for ABOi transplantation. Methods: Eight patients were treated with the commonly used isoagglutinine carbohydrate epitope adsorber and seven with a regenerative polyclonal sheep anti‐immunoglobulin adsorber as part of the preconditioning for ABOi kidney transplantation. An IgG‐isoagglutinine titer of less or equal 1:4 qualified for transplantation. Treatment safety, efficiency, length of desensitization, number of postoperative immunoadsorptions, and allograft outcome were retrospectively compared. Results: With the use of the immunoglobulin adsorber the median initial isoagglutinine IgG titers of 1:64 (range 1:32–1:256) were lowered to the target of 1:4 preoperatively with a mean of 6.2 immunoadsorptions (range 5–11). Mean IgG/IgM titer step reduction per IA was 1.98/1.21 for (range 0–4/0–4) and mean titer step rebound 1.31/0.82 (range 0–4/0–3), respectively. The number of immunoadsorptions and length of desensitization was not different from the use of the specific isoagglutinine adsorbers. After transplantation, no rejection occurred and only one postoperative immunoadsorption was necessary. No adverse events in relation to immunoadsorption were observed. Graft function was comparable to the isoagglutinine adsorber group. Conclusion: These data suggest that ABOi kidney transplantation can be performed safely and effectively with a selective regenerative immunoglobulin immunoadsorber. J. Clin. Apheresis, 2012. © 2012 Wiley Periodicals, Inc.