Objective: To evaluate the mid-term efficacy of ABO incompatible living donor kidney transplantation (ABOi-KT) based on the results of routine renal biopsy for transplantation. Methods: Retrospective collection of clinical data from 23 pairs of ABOi-KT donors and recipients at the First Affiliated Hospital of Sun Yat-sen University from July 2015 to November 2021. ABOi-KT was performed on recipients after desensitization treatment, and the results of routine kidney transplant biopsy at 1 week, 1 month, 3 months, 6 months, and 12 months after surgery were analyzed. Combined with blood type antibody levels and renal function recovery, the mid-term efficacy of ABOi-KT was evaluated. Results: Among the 23 recipients, there were 19 males and 4 females; age range from 19 to 47 years old [(29.6±6.7) years old], all underwent ABOi-KT successfully after receiving desensitization treatment. The follow-up time was (44.6±22.4) months, of which 22 cases were followed up for more than 1 year. The incidence rates of rejection reactions at 1 week, 1 month, 3 months, 6 months, and 12 months after surgery were 15.0% (3/20), 11.1% (1/9), 7.7% (1/13), 25.0% (3/12), and 12.5% (1/8), respectively. For receptors with rejection reactions, targeted anti-rejection therapy was performed based on clinical symptoms and various indicators. Borderline T cell mediated rejection (TCMR) can be converted to mild tubular inflammation after anti-rejection treatment. The positive rate of complement C4d in peritubular capillaries was 95.0% (19/20) one week after surgery, and the positive rate of complement C4d was 100% at 3 and 12 months after surgery. The cumulative survival rates at 1, 3, 5, and 7 years after surgery were all 100%. The cumulative survival rates at 1, 3, 5, and 7 years after kidney transplantation were 100%, 93.3%, 84.0%, and 84.0%, respectively. Except for 2 recipients who underwent transplantation in 2017 and experienced kidney failure at 30 and 49 months after surgery, all other transplanted kidneys survived. Conclusions: The results of routine renal transplant biopsy show that ABOi-KT has a good mid-term therapeutic effect. The pathological changes of ABOi-KT can be dynamically observed through routine renal transplant biopsy and targeted treatment for rejection reactions can be provided accordingly.
目的： 依据程序性移植肾穿刺活检结果对ABO血型不相容活体亲属肾移植（ABOi-KT）的中期疗效进行评价。 方法： 回顾性收集中山大学附属第一医院2015年7月至2021年11月实施的23对ABOi-KT的供受体临床资料，对受体进行脱敏治疗后行ABOi-KT，分析受体术后1周、1个月、3个月、6个月和12个月程序性移植肾穿刺活检结果，结合血型抗体水平、肾功能恢复情况，对ABOi-KT的中期疗效进行评价。 结果： 23例受体中，男19例，女性4例；年龄19~47（29.6±6.7）岁，均在接受脱敏治疗后顺利实施ABOi-KT。随访时间（44.6±22.4）个月，其中随访时间超过1年者22例。术后1周、1个月、3个月、6个月和12个月病理证实排斥反应的发生率分别为15.0%（3/20）、11.1%（1/9）、7.7%（1/13）、25.0%（3/12）和12.5%（1/8）。对于排斥反应的受体，结合临床症状及各项指标行针对性抗排斥治疗，临界性T细胞介导的排斥反应（TCMR）经抗排斥治疗后均可转为轻度小管炎。术后1周管周毛细血管补体C4d阳性率为95.0%（19/20），术后3和12个月时补体C4d阳性率均为100%。受体术后1、3、5和7年生存率均为100%。移植肾术后1、3、5和7年存活率分别为100%、93.3%、84.0%和84.0%，除2017年进行移植的2例受体于术后30和49个月出现移植肾失功外，其余移植肾均存活。 结论： 程序性移植肾穿刺活检结果显示，ABOi-KT的中期疗效良好，可动态观察ABOi-KT病理改变，并对排斥反应行针对性治疗.