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1.
Acta bioquím. clín. latinoam ; 54(3): 285-292, set. 2020. graf, tab
Article in Spanish | LILACS | ID: biblio-1130603

ABSTRACT

Los posibles efectos adversos que se producen en transfusiones incompatibles ABO son un riesgo latente en el uso de concentrados de plaquetas grupo O, por lo que la titulación de hemolisinas anti-A/B constituye una de las estrategias para su prevención. El objetivo de este estudio fue determinar la frecuencia de títulos de hemolisinas de isotipos IgG e IgM anti-A/B en donantes de sangre. Se trató de un estudio descriptivo, transversal y aleatorio simple con un tamaño muestral de 308 muestras. Se aplicó la metodología en tubo, gel salino y anti-inmunoglobulina IgG y, mediante soluciones seriadas, se evidenció el título. Adicionalmente, se realizó una encuesta sobre los posibles factores de riesgo para el aumento de estos títulos. Se aplicó estadística descriptiva mediante el uso del software informático SPSS versión 22.0 y la relación entre variables independientes a través del análisis estadístico de Chi-cuadrado y, para establecer la concordancia de las lecturas visuales de las tarjetas de gel, se aplicó el índice kappa. Se determinó la existencia de hemolisinas de isotipo IgG e IgM anti-A/B de títulos superiores a 1/64. Existió una relación estadísticamente significativa entre embarazos y títulos de IgG anti-A/B >1/128 y el aumento de hemolisinas de isotipo IgM y la ingesta de probióticos. Los resultados demostraron la necesidad de implementar la titulación de hemolisinas previo a la transfusión de concentrados plaquetarios no isogrupo, por lo que se recomienda una investigación de riesgo-beneficio y el seguimiento de pacientes con transfusiones de concentrados plaquetarios incompatibles ABO.


The possible adverse effects that occur in incompatible ABO transfusions are a latent risk in the use of group O platelet concentrates, so the titration of anti-A/B hemolysins is one of the strategies for its prevention. The objective of this study was to determine the frequency of hemolysins titers IgG and IgM anti-A/B isotypes in blood donours. It was a simple randomized descriptive cross-sectional study with a sample size of 308 samples. The methodology was applied in tube, saline gel and anti-IgG anti-immunoglobulin and by means of serial solutions the title was verified. Additionally, a survey was conducted on the possible risk factors for the increase in securities. Descriptive statistics were used through the application of the SPSS version 22.0 software and the relationship between independent variables through the Chi-square statistical analysis and the kappa index was applied to match the visual readings of the gel cards. The existence of IgG and IgM anti-A/B isotype hemolysins of titers greater than 1/64 was determined. There was a statistically significant relationship between pregnancies and anti-A/B IgG titres>1/128; and the increase in IgM isotype hemolysins and probiotic intake. The results demonstrate the need to implement hemolysin titration prior to transfusion of non-isogroup platelet concentrates, so a risk-benefit investigation and follow-up of patients with transfusions of ABO incompatible platelet concentrates is recommended.


Os possíveis efeitos adversos que ocorrem em transfusões incompatíveis ABO são um risco latente no uso de concentrados de plaquetas do grupo O, portanto a titulação de hemolisinas anti-A/B é uma das estratégias para sua prevenção. O objetivo deste estudo foi determinar a frequência de títulos de hemolisinas de isotipos IgG e IgM anti-A/B em doadores de sangue. Trata-se de um estudo descritivo transversal aleatório simples, com tamanho de amostra de 308 amostras. A metodologia foi aplicada em tubo, gel salino e anti-imunoglobulina IgG e utilizando soluções em série, o título foi verificado. Além disso, foi realizada uma pesquisa sobre os possíveis fatores de risco para o aumento destes títulos. A estatística descritiva foi utilizada através da aplicação do software informático SPSS versão 22.0 e a relação entre variáveis independentes por meio da análise estatística do qui-quadrado e, para estabelecer a concordância com as leituras visuais dos cartões de gel, o índice kappa foi aplicado. Foi determinada a existência de hemolisinas de isotipo IgG e IgM anti-A/B de títulos maiores que 1/64. Existiu uma relação estatisticamente significante entre gestações e títulos de IgG anti-A/B>1/128; e o aumento de hemolisinas do isotipo IgM e a ingestão de probióticos. Os resultados demonstram a necessidade de implementar a titulação da hemolisina antes da transfusão de concentrados de plaquetas não isogrupo, por isso, recomenda-se uma investigação de risco-benefício e acompanhamento de pacientes com transfusões de concentrados de plaquetas incompatíveis com ABO.


Subject(s)
Humans , Male , Female , Blood Platelets , Immunoglobulin Isotypes/blood , Software , Immunoglobulin G , Immunoglobulin M , Immunoglobulins , Risk Factors , Probiotics , Hemolysin Proteins , Volunteers , Blood , Blood Donors , Risk , Data Interpretation, Statistical , Morbidity , Titrimetry , Aftercare , Drug-Related Side Effects and Adverse Reactions , Disease Prevention
2.
Article | IMSEAR | ID: sea-204197

ABSTRACT

: Jaundice is the commonest abnormal finding with an incidence of about 60% in term babies and 80% in preterm babies. It is the commonest cause of admission to hospitals in the newborn period. In preterm babies, the percentage is exceedingly high due to their physiological handicaps and other hazards of prematurity like Asphyxia, septicemia, respiratory and circulatory Insufficiency. Non-physiological or pathological jaundice is also known to occur in (8-9)% of newborns. Its timely detection and optimal management are crucial to prevent brain damage and subsequent neuro-motor retardation. Aims of this study to find out the etiology of jaundice in neonates, admitted in neonates unit attached to SMS medical college Jaipur.Method: This Observational study was conducted in Neonatal Intensive Care Unit (NICU) and Post Natal Ward attached to SMS medical college Jaipur, after approval from the hospital ethical committee, over a period of 12 months(October 2011 to September 2012. Study was carried on 500 neonates presenting clinically with neonatal hyperbilirubinemia.Result: The onset of jaundice was seen maximum between live hour 24-72 hours (n=290, 58% cases), followed by live hour 72 hours-14 days (n=160, 32%). At more than 2 weeks there was only 3 case (0.6%). The etiological factors in the causation of jaundice in the decreasing order of frequency were exaggerated physiological jaundice accounts for (28%), ABO-incompatibility (24.4%), Rh-incompatibility (13.8%), Idiopathic (10.4%), cephalhematoma (10.2%), septicemia (6%), intrauterine infections (4%), BMJ (1.8%), Galactocemia (0.8%) and G6PD' Deficiency (0.6%) respectively.Conclusion: Hyperbilirubinemia is more severe in newborns, therefore precautionary measure should be adopted by both parents, and clinicians to diagnose and treat the diseases properly.

3.
Hematol., Transfus. Cell Ther. (Impr.) ; 41(1): 1-6, Jan.-Mar. 2019. tab
Article in English | LILACS | ID: biblio-1002048

ABSTRACT

Abstract Background ABO blood group incompatibility between donor and recipient is associated with a number of immunohematological complications, but is not considered a major contraindication to allogeneic hematopoietic stem cell transplantation. However, available evidence from the literature seems to be conflicting as to the impact of incompatibility on overall survival, event-free survival, transplant-related mortality, graft-versus-host disease, and time to neutrophil and platelet engraftment. Methods This single-center, prospective, cohort study included patients with hematological malignancies who underwent a first allogeneic hematopoietic stem cell transplantation between 2008 and 2014. Patients receiving umbilical cord blood as the stem cell source were excluded from this analysis. The impact of ABO incompatibility was evaluated in respect to overall survival, event-free survival, transplant-related mortality, acute graft-versus-host disease and engraftment. Results A total of 130 patients were included of whom 78 (60%) were males. The median age at transplant was 36 (range: 2-65) years, 44 (33%) presented ABO incompatibility, 75 (58%) had acute leukemia, 111 (85%) had a related donor, 100 (77%) received peripheral blood hematopoietic stem cells as graft source and 99 (76%) underwent a myeloablative conditioning regimen. There was no statistically significant association between ABO incompatibility and overall survival, event-free survival, transplant-related mortality, grade II-IV acute graft-versus-host disease, neutrophil or platelet engraftment in multivariate analysis. Conclusion These results show that ABO incompatibility does not seem to influence these parameters in patients undergoing allogeneic hematopoietic stem cell transplantation.


Subject(s)
Humans , Male , Female , Blood Group Incompatibility , ABO Blood-Group System , Bone Marrow Transplantation , Hematopoietic Stem Cell Transplantation
4.
Article | IMSEAR | ID: sea-206488

ABSTRACT

ABO incompatibility is one of the most common cause of haemolytic disease of fetus and new-born (HDFN). The expression of ABO incompatibility in most of the cases is mild due to the lower expression of A and B Antigens on fetal red cells. ABO incompatibility has affected the first pregnancy and is milder in the subsequent pregnancies.  However, we describe this case with unusually severe form of ABO incompatibility which had an effect not only in her first pregnancy but also in all her subsequent pregnancies, evident as recurrent abortions and both her neonates developed pathological jaundice requiring exchange transfusion. It also emphasizes the fact that ABO incompatibility is not always a benign condition and should be considered in all babies whose mothers have O blood group, even in the presence of a negative DAT. Anticipation of ABO incompatibility not only in the first pregnancy but also in the subsequent pregnancies is necessary. Early diagnosis with cord blood bilirubin can prevent neonatal morbidity.

5.
Organ Transplantation ; (6): 182-2019.
Article in Chinese | WPRIM | ID: wpr-780512

ABSTRACT

Objective To evaluate the clinical efficacy and safety of ABO incompatible living kidney transplantation(ABOi-KT). Methods Clinical data of 11 donors and recipients with ABOi-KT were retrospectively analyzed. All the recipients were treated with desensitization before operation. The recovery condition of renal function and blood type antibody titer of the ABOi-KT recipients were monitored after operation. The incidence of complications and clinical prognosis of ABOi-KT recipients were observed. Results The serum creatinine (Scr) of 11 recipients were well recovered after ABOi-KT. No delay in recovery of graft renal function. Among them, 2 recipients experienced a significant increase in the Scr level at postoperative 14 and 45 d respectively, 1 recipient showed criticality cellular rejection after operation and 1 recipient presented with elevated Scr level at postoperative 33 d, accompanied by an increase in blood type antibody titer. The condition became stable after corresponding treatment. The remaining 7 recipients obtained normal graft renal function and postoperative blood type antibody titer did not rebound. During postoperative follow-up until November 2018, no recipient died or graft renal failure occurred. The survival rate of the recipient and graft renal was 100%. Among them, 3 patients suffered from postoperative complications, including pulmonary infection, BK viruria and granulocytopenia, which were cured after symptomatic treatment. Conclusions ABOi-KT is safe, feasible and yields high long-term clinical efficacy, which can increase the source of living donor kidney and relieve the shortage of donor kidney.

6.
Article in Chinese | WPRIM | ID: wpr-791840

ABSTRACT

Objective To explore the strategies of desensitization treatment for ABO incompatible (ABOi) related living-donor kidney transplantation .Methods A retrospective analysis was performed for 14 recipients undergoing ABOi related living kidney transplantation from July 2015 to December 2018 .The clinical outcomes and expenditures of desensitization treatment before and after optimizing desensitization were compared .Results After desensitization treatment , 14 recipients successfully underwent ABOi-kidney transplantation . Within 2 weeks post-transplantation , blood group antibody rebounded to 1:64 in only 1 recipient .Within 1 week post-transplantation ,the serum creatinine levels decreased to 85-165 μmol/L in 14 recipients .Thirteen patients stabilized after 1 week while another patient had an elevated level of serum creatinine at Day 12 post-operation and renal allograft function recovered after treatment . Two cases of rejection were diagnosed by clinical manifestations and 1 case was confirmed by pathological biopsy . Five cases of programmed renal allograft biopsy indicated critical or suspected acute T-lymphocytic rejection within 1 year .Thirteen cases (92 .6% ) demonstrated varying degrees of peritubular capillary deposition of C 4d .One case developed BK viral uropathy within 1 year and four patients of pulmonary infections requiring hospitalization were cured after treatment . During an early stage , the incidence of postoperative infection was 57 .14% and declined to 14 .29% after optimized desensitization .The expenditure of early desensitization treatment was (27004 .86 ± 10719 .85) yuan and (10612 .29 ± 8143 .05) yuan after optimization .And the expenditure of optimized desensitization was significantly lowered (P<0 .05) . During follow-ups ,renal allograft function of 14 recipients remained decent .And the survival rate of recipient/allograft was 100% up to the statistical cut-off point .Conclusions Both desensitization strategies may achieve the goal of desensitization for ABOi kidney transplantation and the outcomes are excellent .The expenditure of desensitization treatment is significantly lowered after optimization .

7.
An. Fac. Med. (Perú) ; 78(2): 224-229, abr.-jun. 2017. ilus, tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-989265

ABSTRACT

La incompatibilidad de grupo sanguíneo ABO y la sensibilización al HLA constituyen grandes barreras a vencer en pro de la óptima utilización de riñones de donante vivo. Describimos en nuestro medio el primer trasplante renal exitoso ABO incompatible en un paciente de 24 años, retrasplantado renal, altamente sensibilizado (PRA: 89%) y sin opción alguna en disponer de donantes cadavéricos ni familiares. Sin embargo, su único donante vivo HLA compatible era de grupo sanguíneo A incompatible con el grupo O del receptor. El paciente requirió de un régimen precondicionante consistente en recambios plasmáticos, rituximab, imunoglobulina y terapia inmunosupresora cuádruple, a fin de reducir los títulos elevados de isoaglutininas anti A de 1:128 a niveles de seguridad de 1:8, para el éxito del trasplante. Este fue realizado en Coordinación con la Unidad de Trasplante Renal del Hospital Clínic de Barcelona España (HCB). La ausencia de rechazo mediado por isoaglutininas muestra el potencial beneficio del protocolo al remover los anticuerpos anti grupo sanguíneo. A los dos años del trasplante, la función renal se mantiene estable con niveles de creatinina 1,5 mg%. Concluimos que el trasplante renal ABO incompatible (ABOi) es opción viable para pacientes cuyo único donante sea grupo sanguíneo incompatible, y entre nosotros representa esperanzadora fuente de órganos.


ABO blood group incompatibility and HLA sensitization are major barriers that need to be overcome in order to make optimum use of kidneys from living donors possible. We report the first successful ABO- incompatible kidney transplant in a 24-year old, highly sensitized (panel reactive antibodies (PRA) 89% kidney retransplantation patient, who lacked any option to get a cadaveric or family donor. However, the patient's sole HLA-compatible living donor had group A blood incompatible with the recipient's O blood group. The < patient required a pre-conditioning regime that consisted of plasma exchange, rituximab, immunoglobulin, and quadruple immunosuppressive therapy in order to reduce high titers of anti-A isoagglutinins from 1:128 to a safe level of 1:8, for successful transplant. This was performed in coordination with the Renal Transplant Unit of Hospital Clinic de Barcelona (HCB), Spain. Absence of rejection mediated by isoagglutinins shows the potential benefit of a protocol consisting in removing antibodies from the anti-blood group. Two yearsafter transplantation, the kidney function remains stable, with creatinine levels of 1.5 mg%. We conclude that an ABO-incompatible kidney transplant is a viable option for patients whose only donor has blood of an incompatible blood group and for us this represents a hope-inspiring source of organs .

8.
Article in English | WPRIM | ID: wpr-135121

ABSTRACT

PURPOSE: Additional clinical experience and knowledge regarding the barrier to transplantation of ABO blood type incompatibility could reduce the higher rate of infectious complications in ABO-incompatible kidney transplantation. METHODS: A total of 79 ABO-incompatible kidney transplantation (ABOiKT) patients were compared with 260 ABO-compatible kidney transplantation (ABOcKT) patients for basic clinical characteristics, infectious complications, rejection episodes, and graft survival. RESULTS: There were no significant differences in baseline characteristics, rejection rates, or graft survival between the ABOiKT and ABOcKT patients. No significant difference in the infection rate was shown for cytomegalovirus (26.6% vs. 30.0%; P = 0.672), BK virus (19.0% vs. 21.5%; P = 0.752), herpes disease (10.1% vs. 5.0%; P = 0.082), pneumonia (5.3% vs. 3.8%; P = 0.746), or urinary tract infection (8.9% vs. 10.0%; P > 0.999). Female sex (hazard ratio [HR], 2.20; P = 0.003), advanced age (≥60 years) (HR, 2.5; P = 0.019), history of rejection episodes (HR, 2.28; P = 0.016), and history of surgical complications (HR, 4.64; P = 0.018) were significant risk factors for infection. ABO incompatibility demonstrated a tendency toward higher infection risk without statistical significance (HR, 1.74; P = 0.056). CONCLUSION: In spite of immunosuppressant protocol modification, the rate of infectious complications following ABOiKT is still higher than with ABOcKT when a modified desensitization protocol is used. However, this was not sufficient to avoid ABOiKT.


Subject(s)
BK Virus , Cytomegalovirus , Female , Graft Survival , Humans , Kidney Transplantation , Kidney , Pneumonia , Risk Factors , Transplant Recipients , Urinary Tract Infections
9.
Article in English | WPRIM | ID: wpr-135120

ABSTRACT

PURPOSE: Additional clinical experience and knowledge regarding the barrier to transplantation of ABO blood type incompatibility could reduce the higher rate of infectious complications in ABO-incompatible kidney transplantation. METHODS: A total of 79 ABO-incompatible kidney transplantation (ABOiKT) patients were compared with 260 ABO-compatible kidney transplantation (ABOcKT) patients for basic clinical characteristics, infectious complications, rejection episodes, and graft survival. RESULTS: There were no significant differences in baseline characteristics, rejection rates, or graft survival between the ABOiKT and ABOcKT patients. No significant difference in the infection rate was shown for cytomegalovirus (26.6% vs. 30.0%; P = 0.672), BK virus (19.0% vs. 21.5%; P = 0.752), herpes disease (10.1% vs. 5.0%; P = 0.082), pneumonia (5.3% vs. 3.8%; P = 0.746), or urinary tract infection (8.9% vs. 10.0%; P > 0.999). Female sex (hazard ratio [HR], 2.20; P = 0.003), advanced age (≥60 years) (HR, 2.5; P = 0.019), history of rejection episodes (HR, 2.28; P = 0.016), and history of surgical complications (HR, 4.64; P = 0.018) were significant risk factors for infection. ABO incompatibility demonstrated a tendency toward higher infection risk without statistical significance (HR, 1.74; P = 0.056). CONCLUSION: In spite of immunosuppressant protocol modification, the rate of infectious complications following ABOiKT is still higher than with ABOcKT when a modified desensitization protocol is used. However, this was not sufficient to avoid ABOiKT.


Subject(s)
BK Virus , Cytomegalovirus , Female , Graft Survival , Humans , Kidney Transplantation , Kidney , Pneumonia , Risk Factors , Transplant Recipients , Urinary Tract Infections
10.
Article in Korean | WPRIM | ID: wpr-65262

ABSTRACT

Kidney transplantation (KTP) lowers the mortality and morbidity of patients with end-stage renal disease. Post-transplantation infection and antibody mediated rejection (AMR) are the most common complications. Hepatitis B surface antigen (HBsAg) positive carrier donors and high anti A/B antibody titer ABO incompatible KTP could lead to recipient hepatitis B virus (HBV) infection and AMR. Here, we report a case of successful KTP in a 41-year-old male with a high titer of ABO incompatible and HBsAg positive donor. He underwent seven rounds of plasmapheresis, low dose intravenous immunoglobulin and rituximab treatment to inhibit antibody production and remove antibodies from the serum, after which he was administered anti-viral agent for HBV prophylaxis. The recipient maintained successful allograft function for 6 months after transplantation; therefore, we report that desensitization and anti-viral treatment achieved successful outcome in a 1:512 anti A/B antibody titer ABO incompatible and hepatitis B carrier donor KTP.


Subject(s)
Adult , Allografts , Antibodies , Antibody Formation , Hepatitis B Surface Antigens , Hepatitis B virus , Hepatitis B , Hepatitis , Humans , Immunoglobulins , Kidney Failure, Chronic , Kidney Transplantation , Kidney , Male , Mortality , Plasmapheresis , Rituximab , Tissue Donors
11.
Organ Transplantation ; (6): 370-377, 2016.
Article in Chinese | WPRIM | ID: wpr-731648

ABSTRACT

Objective To systematic evaluation the therapeutic effects on patients with ABO-incompatibility liver transplantation (ILT),and compare the curative effect with ABO-compatible liver transplantation (CLT). Methods The literatures of comparison in clinical efficacy between ILT and CLT were collected at home and abroad by computer search in PubMed database,Embase database,Cochrane database,Medline database,Web of science database,CNKI,Wanfang database,VIP database,et al,and the quality of literatures were accessed. Meta analysis was carried out by fixed effect model and random effect model with RevMan5.3 software. Results A total of 18 papers were included. The results of Meta analysis showed that there was no significant difference in the survival rates of recipient between ILT group and CLT group at 1 ,3 and 5 years after operation (all P>0.05 ). Compared with CLT group,the survival rates of grafts were significantly decreased in ILT group at 1 ,3 and 5 years after operation,and the difference was statistically significant (all P<0.05 ). The incidences of postoperative biliary complication and acute rejection in ILT group were significantly higher than those in CLT group,the difference was statistically significant (both P<0.05 ). Conclusions Compared with CLT, the curative effect of ILT is weaker but still can be used as a new choice for critical condition of the recipient or waiting for the donor liver for a long time.

12.
Organ Transplantation ; (6): 283-286, 2016.
Article in Chinese | WPRIM | ID: wpr-731640

ABSTRACT

Objective To observe the clinical efficacy and safety of double filtration plasmapheresis (DFPP)in eliminating blood group antibody in ABO﹣incompatible patients undergoing liver transplantation. Methods Eighteen recipients with ABO﹣incompatible liver transplantation in the General Hospital of Chinese People’s Armed Police from January 2012 to December 2014 were selected in the ABO﹣incompatibility group.The recipients with an antibody titer of anti﹣A or anti﹣B blood group >1∶16 were scheduled to undergo DFPP.Another 20 recipients eligible for blood transfusion were chosen into the control group.The changes in the antibody titer,blood biochemical parameters and the incidence of complications were observed in recipients with ABO﹣incompatible liver transplantation.The incidence of acute rejection and mortality rate between the ABO incompatibility group and control group were statistically compared. Results Among 18 patients,15 with an antibody titer of anti﹣A or anti﹣B blood group >1 ∶16 received DFPP.After DFPP,the mean antibody titer was significantly declined.Detection of blood biochemical parameters indicated that the level of fibrinogen was significantly decreased following DFPP (P =0.0001 ).Among 20 cases receiving DFPP,3 cases presented with hypotension,3 with hemorrhage,1 with nausea and vomiting,and 1 with coagulation in pipeline.All symptoms were alleviated after effective treatment.The incidence of acute rejection and mortality rate did not significantly differ between the ABO﹣incompatibility group and control group after DFPP (both P >0.05). Conclusions DFPP can safely and effectively reduce the level of blood group antibody,decrease the incidence of acute rejection after liver transplantation and enhance the success rate of liver transplantation.

13.
Hanyang Medical Reviews ; : 202-210, 2014.
Article in English | WPRIM | ID: wpr-55232

ABSTRACT

Despite the great potential of ABO-incompatible (ABOi) liver transplantation (LT) for expanding the donor pool, serious concern about poor outcomes in the recipients has been a major obstacle to its widespread. The use of ABOi living donors is an attractive solution for expanding the liver donor pool, and various novel strategies for desensitization of ABO incompatibility have yielded promising results. The 1st breakthrough was local graft infusion therapy introduced by the Keio and Kyoto group; a second, epochal advance was the advent of the anti-CD20 monoclonal antibody, rituximab. Since then, the risk of fulminant hepatic necrosis caused by full-blown antibody-mediated rejection (AMR) has almost disappeared, and survival outcomes of ABOi LT have increased markedly. In the Korean experience, ABOi LT accounts for 18% of all adult living donor liver transplantation, and 3-year graft and patient survival rates are 86.5 and 87.6%, respectively. ABOi living donor LT is thus having a major impact on the donor pool and the recent achievements permit us to promote a nationwide ABOi LT program. However, concern still remains about diffuse intrahepatic biliary stricture (DIHBS), which is an attenuated form of AMR. Ultimately, we need to identify risk factors and preventive measures for this.


Subject(s)
Adult , Antibodies, Monoclonal, Murine-Derived , Constriction, Pathologic , Humans , Liver , Liver Transplantation , Living Donors , Necrosis , Risk Factors , Survival Rate , Tissue Donors , Transplants , Rituximab
14.
Article in Korean | WPRIM | ID: wpr-127452

ABSTRACT

PURPOSE: ABO incompatibility had long been an obstacle in kidney transplantation. However, recent reports showed excellent outcomes. In this study, we evaluated the outcomes of ABO incompatible kidney transplantation with preconditioning protocol using rituximab and plasmapheresis. METHODS: The recipients who had an ABO-incompatible donor and underwent living donor kidney transplantation were enrolled. Preconditioning protocol was pretransplant single dose rituximab with plasmapheresis at pretransplantation 7-10 days. Immune suppression regimen consisted of tacrolimus, mycophenolate mofetil and steroid. Anti-A or anti-B antibody titer was monitored during preconditioning and post transplantation period. RESULTS: 37 patients underwent living donor ABO incompatible kidney transplantation. Median pre-treatment antibody titer was 1:64 and pre transplant antibody titer after 1-6 times of plasmapheresis was 1:2. Median follow-up duration was 332 days (range 156-681). One episode of acute T cell mediated rejection was observed. Mean serum creatinine at 2 weeks was 1.00+/-0.27 mg/dL and at 24 weeks was 1.21+/-0.37 mg/dL. CONCLUSION: ABO incompatible kidney transplantation with rituximab and plasmapheresis can be safely performed. It is therefore a valuable option for expanding donor pool and should be actively performed in Korea.


Subject(s)
Antibodies, Monoclonal, Murine-Derived , Creatinine , Follow-Up Studies , Humans , Kidney , Kidney Transplantation , Korea , Living Donors , Mycophenolic Acid , Plasmapheresis , Rejection, Psychology , Tacrolimus , Tissue Donors , Transplants , Rituximab
15.
Article in Korean | WPRIM | ID: wpr-64861

ABSTRACT

BACKGROUND: Since the time various strategies have been introduced to overcome the ABO-blood barrier including local infusion therapy (LIT), plasmapheresis and rituximab, the graft and patient survival outcome of ABO-incompatible (ABOi) adult living donor liver transplantation (ALDLT) has remarkably improved. But, the need for LIT under rituximab prophylaxis should be reevaluated because of high incidence of the LIT-related complications. The aim of this study was to verify the safety and efficacy of the protocol without local infusion therapy in ABOi ALDLT. METHODS: From November 2008 to December 2010, 43 cases of ABO-incompatible adult living donor liver transplantation were performed. In all cases, the spleen was preserved. From the 1st to 20th case, LIT was employed (group I, n=20). From the 21th case onwards, LIT was eliminated from the protocol (group II, n=23). The 3-month and 1-year patient and graft survival rates were compared between the two groups. The clinical parameters including recipient, donor and graft-related factors were also compared. The graft function was assessed in each group based on the serial changes in serum AST/ALT, total bilirubin and prothrombin time. RESULTS: There was 1 case of in-hospital mortality (2.3%) among the 43 cases. Overall 3-month and 1-year patient and graft survival rate was 97.7% and 92.1% during a mean period of 11.4 +/- 0.4 (0.9~28.9) months. There was no significant difference in the 3-month and 1-year patient and graft survival rates (95.0 vs. 100% and 90.0 vs. 92.9%, P=0.60) between groups. LIT-related complications occurred in 4 patients (20.0%). One case of antibody-mediated rejection occurred in group II. Both groups showed no difference in graft function at postoperative 3rd month. CONCLUSIONS: ABOi ALDLT without splenectomy and LIT resulted in promising outcomes. Therefore, LIT can be safely eliminated from the protocol.


Subject(s)
Adult , Antibodies, Monoclonal, Murine-Derived , Bilirubin , Graft Survival , Hospital Mortality , Humans , Incidence , Liver , Liver Transplantation , Living Donors , Plasmapheresis , Prothrombin , Rejection, Psychology , Rituximab , Spleen , Splenectomy , Tissue Donors , Transplants
16.
Article in Chinese | WPRIM | ID: wpr-595386

ABSTRACT

0.05).The volumes of PBSC collected each time in the 3 groups were about 60 ml,and there were(3.67—10.25)?1010 erythrocytes per pack in the ABO major incompatible group,and 22—38 ml of plasma in ABO minor incompatible component.All the PBSC were infused to recipients without the removal of erythrocytes or plasma,and no haemolytic reaction was observed in any recipients and all their hematopoietic functions were re-established.Conclusion Enough PBSC can be harvested by using CS-3000 Plus blood cell separator from ABO incompatible allogeneic donors.By modification of separator parameters,the number of erythrocytes in the collects can be reduced.The collected PBSC can be safely infused into the blood group incompatible recipients without removal of erythrocytes or plasma.

17.
Article in Chinese | WPRIM | ID: wpr-566723

ABSTRACT

This article presents the experience ofPhysician-in-charge CHEN Ying-yi in treating maternal-fetal ABO incompatibility from four aspects:cause and pathogenesis ofthe disease, treatment thought, special prescription for the disease alone, and treatment experience.Mrs.CHEN Ying-yi considers the damp, heat and stasis pathogen as key factors ofthe disease, and the deficiency ofthe spleen and the kidney as the fundamental reasons.The principle oftreatment is eliminating pathogenic factors and supporting healthy energy, and treating the disease and preventing abortion.Her empirical prescription of‘lianhuang tang(decoction oflotus receptacle and prepared rhubarb )', modified in accordance with the symptoms, has obtained very good curative effect for the treatment ofthis disease.

18.
Article in Korean | WPRIM | ID: wpr-83339

ABSTRACT

BACKGROUDNS: Concentration of bone marrow aspirates is an important prerequisite prior to infusion of ABO incompatible allogeneic marrow and prior to cryopreservation and storage of autologous marrow. We describe our experience in processing 39 bone marrow aspirates harvested for autologous and ABO incompatible allogeneic bone marrow transplantation (BMT) using the blood cell separator, and analyzed removal rates of the red blood cells and recovery rates of the mononuclear cells. METHODS: Between September 1992 and July 1998, 39 bone marrow aspirates were processed using CS3000 Plus (38/39) and COBE Spectra (1/39) cell separators. Among 39 bone marrow harvests, 25 cases were for autologous BMT and 14 cases were for allogeneic BMT with ABO incompatibility. Initial bone marrow and final bone marrow concentration product were analyzed for volume, hematocrit, WBC and mononuclear cell count by manual differential count. RESULTS: Within 60-120 min (mean 81 min), the initial marrow volume 1212 mL (+/-205 mL) was processed. A mean of 31.9% (+/-13.4%) of the initial nucleated cells and 70.1% (+/-27.0%) of initial mononuclear cells was recovered in a mean volume of 214 mL (+/-17 mL). This procedure effectively removed 97% of the red cells and 81% of the granulocytes. CONCLUSIONS: We concluded that automated bone marrow processing with the blood cell separator was an effective method for collecting mononuclear cells while removing red blood cells, granulocytes, and plasma.


Subject(s)
Blood Cells , Bone Marrow Transplantation , Bone Marrow , Cell Count , Cryopreservation , Erythrocytes , Granulocytes , Hematocrit , Plasma
19.
Article in Korean | WPRIM | ID: wpr-32575

ABSTRACT

ABO incompatible organ transplantation has been contraindicated because of acute rejection or hyperactive rejection by its antigen-antibody reaction. To overcome these problems, plasma pheresis, antibody adsorption and other diverse methods have been tried by many investigators. The authors experienced a case of orthotopic liver transplantation across the ABO incompatibility by using plasma pheresis. The recipient was a 3-year-old male with blood type B, and the donor was his father with blood type AB. Perioperative plasma pheresis was performed a total of four times. The initial anti-A titer was 1:64; after the plasma pheresis, the titer was weakened to 1:4. Orthotopic liver allografting was successfully accomplished without hyperacute rejection. The usual mild acute rejection symptom was noted, but no serious problem developed. As in this experience, an ABO incompatible liver transplant is not an absolute, but a relative, contraindication. Selecting the proper candidate and using plasma pheresis should be a good optional approach for ABO incompatible transplantation patients.


Subject(s)
Adsorption , Allografts , Antigen-Antibody Reactions , Blood Component Removal , Child , Child, Preschool , Fathers , Humans , Liver Transplantation , Liver , Male , Organ Transplantation , Plasma , Research Personnel , Tissue Donors , Transplantation, Homologous , Transplants
20.
Article in Korean | WPRIM | ID: wpr-157001

ABSTRACT

To overcome the shortage of available organ in children, living-related liver transplantation(LRLT) has been introduced in Asan Medical Center since 1994. However, the use of graft livers across ABO blood groups is unavoidable since the organ donor is usually one of the recipient's parents in LRLT cases. In ABO-incompatible liver transplants from brain dead donors, the incidences of perioperative mortality, arterial thrombosis, and irreversible rejection and the rate of retransplantation have been reported to be greater. But recent reports from LRLT showed that 1-year survival rate of ABO incompatible cases were approximately 80%. So we started ABO incompatible LRLTs at our institute since Feb, 1996. Three cases of ABO incompatible LRLT have been performed thereafter, 2 with fulminant hepatitis and 1 with cirrhosis. Plasma pheresis or exchange transfusion was done to decrease isohemagglutinin perioperatively. Immunosuppression consisted of a quadruple-drug treatment in one, FK506 and steroid in two. The follow-up periods were 2, 4 and 13 months respectively. One child died of acute respiratory distress syndrome with normal graft function on 51st postoperative day. Two children are alive with good health, but one of them suffers S2 segment bile duct stricture, which is under the management with PTBD. The present results suggest that ABO incompatilbe LRLTs can be performed to overcome the shortage of the liver in children using a combination of the preioperative plasma pheresis and immunosuppression.


Subject(s)
Bile Ducts , Blood Component Removal , Blood Group Antigens , Brain Death , Child , Constriction, Pathologic , Fibrosis , Follow-Up Studies , Hepatitis , Humans , Immunosuppression Therapy , Incidence , Liver Transplantation , Liver , Mortality , Parents , Plasma , Respiratory Distress Syndrome , Survival Rate , Tacrolimus , Thrombosis , Tissue Donors , Transplants
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