TAKAHASHI Kota Dept. of Urology. Tokyo Women's Medical College. Associate Professor., 医学部, 助教授 (90101857)
HAYASAKA Yutaro Dept. of Surgery. Tokyo Women's Medical College. Assistant Professor., 医学部, 講師 (30120033)
AGISHI Tetsuzo Dept. of Surgery. Tokyo Women's Medical College. Professor., 医学部, 教授 (70090660)
SHIMIZU Masaru Dept. of Transfusion. Tokyo Women's Medical College. Professor., 医学部, 教授 (20048987)
NAKAJIMA Kazuo Dept. of Surgery. Tokyo Women's Medical College. Assistant
TANABE Kazunari Dept. of Urology. Tokyo Women's Medical College. Assistant., 医学部, 助手 (80188359)
OOBA Shinobu Dept. of Urology. Tokyo Women's Medical College. Assistant.
|Budget Amount *help
¥18,000,000 (Direct Cost : ¥18,000,000)
Fiscal Year 1992 : ¥4,300,000 (Direct Cost : ¥4,300,000)
Fiscal Year 1991 : ¥4,300,000 (Direct Cost : ¥4,300,000)
Fiscal Year 1990 : ¥3,900,000 (Direct Cost : ¥3,900,000)
Fiscal Year 1989 : ¥5,500,000 (Direct Cost : ¥5,500,000)
In an effort to extend the opportunity of kidney transplantation, we treated the blood of ABO-incompatible patients or the blood of preformed antibodies-positive patients prior to transplantation by plasma exchange and/or immunoadsorption in order to eliminate anti-A, anti-B antibodies or preformed antibodies. As a result, we successfully widened the opportunities for kidney transplantation. (1) ABO-incompatible kidney transplantation
The patients were 49 chronic renal failure patients who received kidney transplantation at our center between January 1989 and November 1992. Their age range was 35 * 13 (8 to 58 year old). Twentynine patients were male and 20 were female. As for the blood type, eighteen cases were A_1^+-type donor to 0^+ type recipients, A_1^+ to O^-: 1 case, B^+ to O^+:16 cases, B^+ to A_1^+: 4 cases,A_1B^+ to A^+: 6 cases, A_1B^+ to B^+: 2 cases,A_1B^+ to O^+: 1 case, A_1B^- to O^+: 1 case. The number of HLA A.B.DR mismatches were 2.3 * 1.4 and mixed lymphocyete culture
1 way stimulation index was 21.1 * 18.9.
Prior to the transplantation, double filtration plasmapheresis and/or immunoadsorption using a Biosynsorb A or B immunoadsorpiton column (Chembiomed. Ltd., Edomonton, Alberta, Canada) were performed. until the serum anti-A and/or anti-B antibody titer lowered to 1:16 or below. A splenectomy was carried out either before or after the kidney transplantation. Initial immunosuppressive therapy was quintuple consisting of ciclosporin(8 mg/kg), azathioprine(2mg/kg), methyprednisolne(125mg/day), prophylactic use of equine antilymphocyte globulin(30mg/kg for 14 days) and deoxyspergulin(5mg/kg for 5 days).
The patient survival rates were 100% at 1-2 months, 98% at 3-6 months, 93% at 7-12 months, 91% at 1-3 years respectively. The graft survival rates were 94% at 1-2 months, 89% at 3-6 months, 81% at 7-12 months. 78% at 1-3 years respectively. Of 49 patients, rejection did not occur in 19 cases(39%) Hyperacute rejection occurred once in 1 case. Accelerated acute rejection occurred once in 4 cases. Acute rejection occured once in 16 cases, twice in 4 cases, 3 times in 2 cases, 4times in 3cases, and 6 times 1 case. Graft loss caused by rejection occurred in 5 cases. Kidney function has been maintained satisfactory in the remaining cases. Unfortunately, there were four deaths by complications. (2) Kidney transplantation in preformed antibodies-positive patients
DEPP and immunoadsorption were done 3 to 9 times prior to the transplantation in order to remove T-cell antibody, The immunosuppressant administration and the transplantation were carried out in a same manner as in the ABO-incompatible cases. Acute rejection occurred once in two cases. Graft loss ocurred in 2 cases due to chronic rejection and in 1 case due to hyeracute rejection respectively. Good kidney function has been maintained in the remaining 5 cases.