摘要
目的探讨不同方案利妥昔单抗在ABO血型不相容肾移植(ABOi-KT)中应用的利弊,总结合理利用利妥昔单抗使用方案。方法 33例ABOi-KT受者,术前均使用MMF+FK506等10~14 d,配合血浆置换和血浆双重滤过。利妥昔单抗的使用有如下4个不同方案:方案一,术前24 h内单次使用利妥昔单抗500 mg;方案二,术前1周和术前24 h内各使用利妥昔单抗500 mg;方案三,术前2周、术前1周和术前24 h内分别使用利妥昔单抗200、200、500 mg;方案四:术前2周、术前1周和术前24 h内分别使用利妥昔单抗200、200、100 mg。监测4组患者不同时间点血型抗体滴度。统计各组血浆处理次数、使用血浆量,比较不同组别对比术后人肾脏存活率、1年内的感染发生率。结果除方案二中1例出现急性排斥反应,行移植肾切除外,余32例ABOi-KT均取得成功,未出现大出血和肾功能延迟恢复。方案一配合血浆置换和血浆双重滤过次数最多,使用血液制品也最多,方案三和四最少;方案三和四中术后2周内血型抗体滴度反弹较其他方案慢。结论 (1)联合应用免疫抑制剂、血浆置换和(或)双重血浆置换、利妥昔单抗等方法处理ABOi-KT受者是安全有效的;(2)早期低剂量使用利妥昔单抗方案(方案四)是安全有效的,同时可以减少移植受者血浆处理次数,减少术后血型抗体反弹概率,减少手术费用。
Objective To explore the pros and cons of the application of different protocols of rituximab usage in ABO blood group incompatible renal transplantation （ ABOi - KT）, and to summarize the experience. Methods Thirty - three recipients of ABOi - KT were studied. MMF ＋ FKS06 were used 10 to 14 days before operation. Plasma exchange （PE） and （or） plasma double filtration （DFPP） were performed before transplantation. The usage of rituximab has the following four different protocols ： Protocol 1, a single dose of 500 mg rituximab was used within 24 hours before surgery ; Protocol 2, rituximab was used 1 week and 24 hours before surgery, each with 500 mg; Protocol 3 ： rituximab was used 2 weeks, 1 week, and 24 h before surgery, with the dose of 200 rag, 200 rag, and 500 mg, respectively ; Protocol 4 ： ritux- imab was used 2 weeks, 1 week, and 24 h before surgery, with the dose of 200 mg, 200 mg, and 100 mg, respectively. Patients in each of the four groups were monitored at different time points for blood group antibody titers. The times of plasma apheresis, the total use of plasma and red blood cells were calculated. Postoperative renal survival rate, patient survival rate, and incidence of infection in 1 year were compared among groups. Results Thirty - two cases of ABOi - KT were successful, no massive bleeding or delayed graft function was found. One case in Protocol 2 suffered from acute rejection, which resulted in transplant failure. Patients in Protocol 1 received the most sessions of PE and DFPP, with the largest amount of use of plasma and other blood products. Patients in Protocol 3 and 4 received the least. Blood group anti- body titer rebound was also slower in patients in Protocol 3 and 4. Conclusion It is safe and effective to perform ABOi - KT with combined use of immunosuppressive agents, PE and （or） DFPP, and rituximab. Early use of rituximab with low dose （ Protocol 4） is safe and effective, which can reduce the times of plasma apheresis needed, the risk of postoperati
出处
《广东医学》
CAS
北大核心
2017年第19期3014-3018,共5页
Guangdong Medical Journal
基金
国家自然科学基金资助项目(编号:3097299)
南华大学"蒸湘学者计划"资助
