摘要
目的探讨脱敏治疗在高度致敏受者肾移植中的应用疗效。方法回顾性分析25 例群体反应性抗体峰值≥ 30%的高致敏患者行同种异体肾移植术的临床资料。男性8 例,女性17 例,平均年龄( 45±12)岁。首次接受移植者8例,二次移植者 15例,三次移植者 2例,输血史 17例,妊娠史 12例。3 例为亲属供体肾移植,其余均为尸体供体肾移植。术前行血浆置换或蛋白A 免疫吸附+利妥昔单抗+静脉注射丙种球蛋白脱敏治疗。术前交叉淋巴毒试验阴性。采用兔抗人胸腺细胞免疫球蛋白和甲泼尼龙免疫诱导,术后他克莫司+吗替麦考酚酯+皮质激素三联维持治疗。结果其中20(20/25)例患者移植后1 周内血肌酐降至正常。1 例出现超急性排斥反应,于手术当天切除移植肾,1 例于术后第3 天出现加速性排斥反应,血浆置换3 次治疗无效,于术后第7 天切除移植肾,4 例出现移植肾功能延迟恢复,术后第18 ~ 25 天肾功能恢复正常。发生急性排斥反应5 例(20%),其中2 例诊断为抗体介导急性排斥反应,经血浆置换治疗3 次和兔抗人胸腺细胞免疫球蛋白冲击治疗1 周后逆转,其余3 例为细胞性排斥反应经激素冲击治疗后逆转,1 年移植肾存活率92%(23 / 25)。结论高致敏受者肾移植在良好人类白细胞抗原(humanleukocyte antigen,HLA)配型,尽量避开受者预存的抗HLA 抗体位点的前提下,术前采用血浆置换或免疫吸附联合利妥昔单抗、静脉注射丙种球蛋白进行脱敏治疗,能有效预防和治疗急性排斥反应。
Objective To summarize the clinical experience of renal transplantation in highly sensitized recipients. Methods Allogeneic kidney transplantation was performed in 25 hypersensitized patients with panel reactive antibody peak ≥ 30%. There were 8 males and 17 females. The average age was( 45±12). There were 8 patients who underwent transplantation for the first time,15 patients with secondary transplantation, 2 patients with three transplants, 17 patients with a history of blood transfusion,and 12 patients with a history of pregnancy. There were 3 patients with living donor kidney transplantation,and the rest were cadaveric donor kidney transplants. Preoperatively, plasma exchange or protein A immunosorbent + rituximab + intravenous gamma globulin desensitization were performed. Preoperative cross lymphatic toxicity test was negative. Rabbit anti-human thymocyte immunoglobulin and methylprednisolone were induced, and tacrolimus +mycophenolate mofetil + corticosteroid triple maintenance therapy was used. Results The serum creatinine was decreased to normal in 20( 20/25) patients within 1 week after transplantation. The hyperrejection occurred in 1 patient, and the transplanted kidney was removed on the day of surgery. The accelerated rejection occurred in 1 patient on the 3 d after surgery,plasma exchange therapy was ineffective for 3 times,the transplanted kidney was removed on the 7 d after surgery. The delayed recovery of graft function occured in 4 patients, and renal function was returned to normal between 18 and 25 d after surgery. Acute rejection occurred in 5 patients( 20%), of which 2 patients were diagnosed with the reversal of antibody mediated acute rejection after 3 times of plasma exchange therapy and 1 week of fiverine shock therapy, and the remaining 3 patients were the reversal of cellular rejection after steroid bolus therapy. The 1 year survival rate of transplanted kidney was 92%( 23/25). Conclusion Renal transplantation of highly sensitized recipients could effectively prevent and treat acut
作者
莫春柏
宋文利
王智平
付迎欣
史晓峰
冯钢
王辉
赵杰
裴广辉
涂金鹏
王振
沈中阳
Mo Chunbai;Song Wenli;Wang Zhiping;Fu Yingxin;Shi Xiaofeng;Feng Gang;Wang Hui;Zhao Jie;Pei Guanghui;Tu Jinpeng;Wang Zhen;Shen Zhongyang(Tianjin First Central Hospital,Tianjin Key Laboratory of Organ Transplantation,Tianjin 300192,China)
出处
《实用器官移植电子杂志》
2019年第3期194-197,共4页
Practical Journal of Organ Transplantation(Electronic Version)
关键词
群体反应性抗体
高致敏
肾移植
脱敏治疗
Panel reactive antibody
High sensitization
Renal transplantation
Desensitization therapy
