著者
高橋 公太
出版者
一般社団法人 日本臓器保存生物医学会
雑誌
Organ Biology (ISSN:13405152)
巻号頁・発行日
vol.18, no.1, pp.11-32, 2011-01-10 (Released:2013-11-26)
参考文献数
27
被引用文献数
1

It has now been over 20 years since we performed our first ABO-incompatible kidney transplantation(ABO-IKTx)in Japan. During that time about 1700 ABO-IKT have been performed. Since 2001 the success rate for these kidney transplants has been 96% for 1-year graft survival and 91% for 5-year graft survival, similar to results for ABO-compatible KTx. This dramatic improvement in results means that this transplantation procedure has become accepted for curative therapy in end-stage renal failure. Today ABO-IKTx accounts for 30% of all living KTx performed in Japan.In the 100 years since Karl Landsteiner discovered human ABO blood groups, the common wisdom has been that organ transplantation between incompatible blood groups would result immediately in hyperacute rejection and graft loss. However, this concept turned out to be a completely unsupported assumption. We provided epidemiological proof that hyperacute rejection was not caused by the ABO histo-blood group antigens(ABO HBGAS).We have reported elsewhere our two new ground-breaking findings regarding ABO-IKTx. We are confident that these findings will overturn the conventional wisdom about ABO-IKTx, and will mark a fundamental change in treatment strategies.The first finding involves ABO HBGAS, which are classed as carbohydrate antigens.Conventionally, emphasis has been placed on the saccharide chains only, and related phenomena have been interpreted accordingly. However, the saccharide chains in ABO histo-blood group antigens are present in the form of glycoproteins, and the binding proteins are termed " carrier proteins ". By employing proteomic analysis, we discovered that these binding proteins differ between the ABO HBGAS on the erythrocytic surface and those on the vascular endothelial cell surface. These new facts make it necessary to divide the ABO HBGAS into two broad categories.The antigens on the erythrocyte surface are ABO blood group antigens, while the antigens on the vascular endothelial cell surface are ABO histo group antigens.The lymphocytes probably do not identify the saccharides and binding proteins separately, but instead recognize them as part of a whole, and then proceed to form antibodies that have a high affinity for that whole. In other words, the recipient's anti-A/anti-B natural antibodies are primarily anti-ABO blood group antibodies, which do not have much affinity for the ABO histo group antigens on the vascular endothelial cell surface in the transplant organ. This is the main reason that hyperacute rejection is not induced by ABO incompatibility. The second finding relates to the known fact that ABO-incompatibility associated acute antibody-mediated rejection is caused by anti-A/anti-B antibodies. Conventionally it had been believed that this rejection response was caused by natural antibodies present in the recipient. However, if we consider the first theory, it becomes clear that the antibodies eliciting acute antibody-mediated rejection could not be produced without transplantation of the donor organ. That is to say, the recipient lymphocytes must be sensitized to the ABO histo group antigens on the vascular endothelial cells, resulting in the new production of anti-A/anti-B de novo antibodies. We have proven this fact indirectly elsewhere.After considering the new findings described above, we have established pretransplant desensitization therapy as the cornerstone of our transplantation treatment strategy.

言及状況

外部データベース (DOI)

Twitter (1 users, 1 posts, 0 favorites)

血液型不適合 https://t.co/kKnUrC92RH

収集済み URL リスト