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      저자 : Farnaz Nobi (검색결과 1 건)
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        Experiences of performing ABO-incompatible kidney transplantation in Bangladesh

        Nura Afza Salma Begum,Tasnuva Sarah Kashem,Farnaz Nobi,Shakib Uz-Zaman Arefin,Harun Ur Rashid 대한이식학회 2022 Korean Journal of Transplantation Vol.36 No.2

        Background: The number of end-stage renal disease (ESRD) patients is increasing in Bangladesh. Currently, living kidney donation is the only viable option for transplan- tation in Bangladesh, and it is further restricted by ABO compatibility issues. We have performed ABO-incompatible kidney transplantations (ABOi KTs) in Bangladesh since 2018. This study examines our experiences with seven cases of ABOi KT. Methods: The desensitization protocol included low-dose rituximab (100 mg/body) fol- lowed by plasma exchange (PEX), which was followed by a 5-g dose of intravenous im- munoglobulin. Immunosuppression was undertaken using tacrolimus (0.1 mg/kg/day), mycophenolate mofetil (1,500 mg/day), and prednisolone (0.5 mg/kg/day). All patients received basiliximab for induction therapy. Results: The median baseline anti-ABO antibody titer was 1:64 (range, 1:32–1:128). Transplantation was performed at a titer of ≤1:8. Our patients attended three to five PEX sessions before transplantation. Graft survival was 100% in the seven cases over a mean period of 22 months. The mean creatinine level was 204.6±47.4 μmol/L. Two patients were suspected of having developed acute rejection and received intravenous methylprednisolone, resulting in improved kidney function. One patient required post- transplant hemodialysis due to delayed graft function and subsequently improved. In- fection was the most common complication experienced by ABOi KT patients. Two pa- tients developed severe cytomegalovirus pneumonia and died with functioning grafts. Conclusions: ABOi KT in Bangladesh will substantially expand the living kidney donor pool and bring hope to a large number of ESRD patients without ABO-compatible do- nors. However, the high cost and risk of acute rejection and infection remain major con- cerns.

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