Abo-Incompatible Kidney Transplantation
ABO incompatible kidney transplantation is indicated for patients for whom no ABO-identical or minor mismatch donor is available. Since the author and his colleagues performed the first ABO-incompatible kidney transplantation in Japan in 1989, 400 such transplantations have been performed in 41 hospitals in Japan and this practice has contributed to a number of new developments. One is a clearer and more suitable model for conceptualising the mechanism of humoral immune response which enables identification of antigens and antibodies and a therapeutic strategy against rejection. The rejection mechanisms are discussed not only from the perspective of immunology but also viewed from different angles, including anatomy, microscopic and macroscopic pathology, molecular biology and haematology. Immunosuppressive therapy is discussed, divided in four categories: extracorporeal immunomodulation with removal of humoral antibodies; drug therapy to suppress cellular immunity; splenectomy; and anticoagulation therapy. Surgical procedures for kidney transplantation and splenectomy are treated, including discussion of the best timing for the latter. The book gives an overview of the current status with statistics and results of questionnaires and ends with discussions of 17 case histories.
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4x for IgM ABO blood type ABO-incompatible kidney transplantation ABO-incompatible transplantation acute humoral rejection adverse drug reactions anti-A antibody titer anti-B antibodies antibody production antibody removal antibody titer anticoagulation therapy antigens antimetabolites artery biopsy Biosynsorb calcineurin inhibitor cellular rejection chronic rejection ciclosporin clinical course deoxyspergualin dialysis donor age donor and recipient dose ESRD due factors ganciclovir glomerular capillary graft loss Graft survival rate HLA-A immunoadsorption immunosuppressive agent immunosuppressive therapy incompatible induction period infection intrarenal Japanese Society kidney function kidney graft Living kidney transplantation lymphocytes membrane mg/day mg/dl mg/kg/day mismatches mizoribine month posttransplant mycophenolate mofetil ng/ml Niigata OKT3 patient survival rate plasma exchange plasma separator plasmapheresis preformed antibodies procedure recipient age renal transplantation serum creatinine splenectomy steroid suppress surgery surgical T-cell tacrolimus Takahashi Tanabe thrombus thrombus formation transplant kidney transplant patients Transplant Proc transplantation in Japan treatment trough levels urinary