双重滤过血浆置换去除ABO血型不相容肾移植受者血型抗体及其对移植肾存活的影响研究*

doi:10.3969/j.issn.1672-5069.2026.02.021

Abstract

Abstract: Objective The aim of this study was to investigate the safety and clinical efficacy of double filtration plasmapheresis (DFPP) in ABO-incompatible kidney transplantation (ABOi-KT). Methods 80 patients with renal failure were encountered in our hospital between January 2020 and December 2021, all received ABOi-KT, and underwent DFPP in 62 cases, and underwent plasma exchange (PE) in 18 cases for removal of blood type antibodies before KT. Serum A/B IgM and IgG antibodies were determined by column agglutination technology (CAT). Result In DFPP group, serum antibody titers of all blood types decreased significantly after removal, except for serum IgM anti-B antibody; in the PE group, only serum IgG anti-A showed remarkably decreased; there was no significant difference as respect to overall removal of serum antibodies between the two methods; there were no removal-related adverse reactions in the perioperative period in either group; three patients (4.8%) in the DFPP group experienced dysfunctions of the transplanted kidney, and four patients (6.4%) died. Conclusion DFPP exhibits efficacious and safe for removal blood type antibodies before ABOi-KT, which warrants further clinical investigation.

Key words: Double filtration plasmapheresis, Plasma exchange, ABO incompatibility, Kidney transplantation

Jiang Shouwei, Hu Dongyan, Shen Qiang, et al. Application of double filtration plasmapheresis in ABO-incompatible kidney transplantation: An analysis of 80 cases[J]. Journal of Practical Hepatology, 2026, 29(2): 245-248.

References

[1] Takahashi K, Saito K. ABO-incompatible kidney transplantation. Transplant Rev (Orlando),2013,27(1):1-8.
[2] 蒋鸿涛,李涛,任坤,等.ABO血型不相容亲属活体肾移植的多中心研究.中华器官移植杂志,2020,41(5):259-264.
[3] Speer C, Kälble F, Nusshag C, et al. Outcomes and complications following ABO-incompatible kidney transplantation performed after desensitization by semi-selective immunoadsorption - a retrospective study. Transpl Int,2019,32(12):1286-1296.
[4] Kim DG, Lee J, Kim MS, et al. Outcomes of ABO-incompatible kidney transplantation in older patients: a national cohort study. Transpl Int,2021,34(2):290-301.
[5] Lee CY, Yang CY, Lin WC, et al. Prognostic factors for renal transplant graft survival in a retrospective cohort of 1000 cases: The role of desensitization therapy. J Formos Med Assoc,2020,119(4):829-837.
[6] Mitomo A, Tanabe K, Muraoka S C, et al. Prophylactic use of eculizumab for ABO-blood type incompatible kidney transplantation with extremely high ABO-blood type antibody titer: A two case report. Transpl Immunol,2025,90:102213.
[7] Kim HJ, Chung Y, Kim H, et al. Long-term isoagglutinin monitoring after ABO-incompatible kidney transplantation. Am J Clin Pathol,2025,163(2):290-297.
[8] 杨昊,董树岭,杨乾坤,等.双重滤过血浆置换和血浆置换对ABO血型不容肾移植受者术前血型抗体去除效果单中心对比研究.临床输血与检验,2024,26(3):325-331.
[9] 王毅,蒋鸿涛.ABO血型不相容亲属活体肾移植技术操作规范(2019年版).器官移植,2019,10(5):533-539.
[10] 戴兵,曾力,张雷,等.器官移植相关的血液净化技术规范(2019年版).器官移植,2020,11(2):208-221.
[11] 中华医学会感染病学分会肝衰竭与人工肝学组.非生物型人工肝治疗肝衰竭指南(2016年版).中华临床感染病杂志,2016,9(2):97-103.
[12] Ng MSY, Ullah S, Wilson G, et al. ABO blood group relationships to kidney transplant recipient and graft outcomes. PLoS One,2020,15(7):e0236396.
[13] Song SH, Lee J, Kim BS, et al. Successful launch of an ABO-incompatible kidney transplantation program to overcome the shortage of compatible living donors: experience at a single center. Clin Nephrol, 2017, 88(9):117-123.
[14] Eisner S, Orlin J, Nesher E, et al. ABO incompatible kidney transplantation. Harefuah,2017,156(4):237-241.
[15] Alexandre GP, Squifflet JP, De Bruyère M, et al. Present experiences in a series of 26 ABO-incompatible living donor renal allografts. Transplant Proc,1987,19(6):4538-4542.
[16] Nair P, Gheith O, Al-Otaibi T, et al. Management of chronic active antibody-mediated rejection in renal transplant recipients: Single-center experience. Exp Clin Transplant,2019,17(Suppl 1):113-119.
[17] 胡文刚,肖亚,宋亚军,等.硼替佐米治疗肾移植术后AMR的用药时机对治疗效果的影响.中华器官移植杂志,2019,40(8):462-467.
[18] Böhmig GA, Farkas AM, Eskandary F, et al. Strategies to overcome the ABO barrier in kidney transplantation. Nat Rev Nephrol,2015,11(12):732-747.
[19] 邱江,陈国栋,阮和欢,等.ABO血型不相容亲属活体肾移植的脱敏治疗.中华器官移植杂志,2019(8):478-483.
[20] 张洪宪,赵磊,侯小飞,等.血浆置换治疗肾移植术后抗体介导的急性排斥反应的疗效观察.中华泌尿外科杂志,2015,36(1):20-23.
[21] 刘洪涛,张乐希,刘潜,等.双重血浆滤过与血浆置换在ABO血型不相容肾移植术前预处理中的对比研究.中华器官移植杂志,2020,41(10):603-607.
[22] Wagner JE. Umbilical cord transplantation. Leukemia,1998,12(Suppl 1):S30-S32.
[23] Thalgahagoda S, Webb NJ, Roberts D, et al. Successful ABO incompatible renal transplantation following rituximab and DFPP after failed immunoadsorption. Pediatr Transplant,2014,18(3):E74-E76.
[24] 张媛媛,应美爱,潘健,等.血浆置换在ABO血型不相容的亲属活体肾移植中应用效果评价.临床输血与检验,2021,23(2):167-172.

Application of double filtration plasmapheresis in ABO-incompatible kidney transplantation: An analysis of 80 cases

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[10]	Zhang Xiuling, Duan Zhiwen, Yang Ruidong, Zhang Xiaomin, Yang Li, Yang Haiqiu, Li Wu. Plasma exchange combined with double plasma molecular adsorption system in treatment of patients with liver failure [J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2019, 22(2): 289-290.
[11]	Zhang Jing, Yin Fang, Luo Guanhong, et al.. Effect of plasma exchange and sequential double plasma molecular adsorbent therapy on short survival in patients with hepatitis B virus-induced acute on chronic liver failure [J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2019, 22(1): 85-88.
[12]	Yang Xiaoling, Zhou Qiang, Zheng Chunhua, et al. Analysis of plasma exchange and continuous blood purification in treatment of patients with hepatitis B liver failure [J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2018, 21(3): 469-470.
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[14]	Wang Chaoxu, Li Yening, Wang Wenlong, et al.. Efficacy and cytokine changes in patients with acute-on-chronicliver failure receiving plasma exchange and bilirubin adsorption [J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2017, 20(4): 492-493.
[15]	Fan Jinghua, Chen Hongying, Wang Hongtu. Plasma exchange combined with plasma perfusion in treatment of patients with liver failure [J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2016, 19(2): 184-186.