Il trapianto di rene da donatore vivente ABO-Incompatibile

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COD: 283-288 Categorie: ,

Enzo Capocasale, Maurizio Iaria, Maria Sassi, Raffaele Dalla Valle, Maria Patrizia Mazzoni, Mario Sianesi, Massimo Franchini

Ann. Ital. Chir., 2011 82: 283-287

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it provides a superior immunological compatibility, it lessens the preservation-mediated graft injury and it shortens waiting
time on dialysis.
Unfortunately, about 30-35% of potential living kidney donors are rejected because of incompatible immunological barriers
such as ABO-incompatibility or a positive crossmatch.
The newest desensitization protocols based on both therapeutic apheresis and perioperative immunosuppressive drugs allowed
to overcome antibodies barriers.
The aim of those protocols is to wash-out and suppress as much anti-A or anti-B antibodies as possible and to prevent
the rebound phenomena after transplantation.
Standard plasmapheresis, double-filtration plasmapheresis and selective immunoadsorption are among the most common
apheretic modalities applied in ABO-incompatible transplantation.
Furthermore, selective immunoadsorption appears to be much safer and to have markedly increased efficacy comparing
with plasmapheresis being able to eliminate almost exclusively blood-group antibodies avoiding plasma and coagulation
abnormalities. According to literature, long-term patient and graft survival rates are similar to those achieved by ABOcompatible
kidney transplants. The comparable outcome seems related to more effective desensitization protocols as well
as the protective immune mechanisms of “accommodation”.
We have been using selective immunoadsorption in the two ABO-incompatible kidney transplants performed in our institution.
No acute rejection was experienced at 6 and 26 month follow-up and both grafts are functioning well.
Despite the ABO-incompatible kidney transplant widespread use, the best desensitization protocol, the upper baseline and
perioperative isoagglutinin titer limit and the most accurate isoagglutinin measurement assay are still to define.

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