脱敏预处理对高致敏活体肾移植受者PRA水平和疗效的影响  

Influence of desensitization pretreatment on panel reactive antibody and clinical outcome in highly sensitized living renal transplantation recipients

作　　者：黄伟[1] 昌盛[1] 张伟杰[1] 陈刚[1] 郭辉[1] 陈孝平[1] 周平[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院器官移植研究所,武汉430030

出　　处：《器官移植》2010年第4期216-220,共5页Organ Transplantation

基　　金：湖北省自然科学基金重点项目(2007ABD005);湖北省研究与开发计划项目(2008BBC010)

摘　　要：目的分析双重滤过血浆置换(double filtration plasmapheresis,DFPP)等脱敏处理对等待活体肾移植的高致敏患者的群体反应性抗体(panel reactive antibody,PRA)滴度以及对移植术后疗效的影响。方法 11例PRA强阳性(人类白细胞抗原Ⅱ类抗体>80%)患者为研究对象,所有患者既往均有肾移植史。其中5例为实验组,于手术前隔日行DFPP(3～7次),加用免疫抑制剂。实验组患者每次DFPP前后抽取的血清及滤过弃物均采用流式细胞法测定PRA滴度变化。其余6例患者为对照组,移植前未作脱敏预处理。术后观察排斥反应发生情况及临床疗效。结果实验组早期第1例患者做了7次DFPP并加其它免疫处理,前5次抗体滴度明显下降,但后两次处理后抗体出现反弹。其余4例患者经3～5次DFPP处理后,抗体滴度不断下降。移植术后11例患者均未发生超急性排斥反应,实验组中有1例(1/5)发生细胞性排斥反应,而无体液性排斥反应,对照组中有4例(4/6)发生细胞性排斥反应,有3例(3/6)并发体液性排斥反应。结论 DFPP结合其它免疫处理方法进行脱敏预处理,能有效降低肾移植术前PRA滴度,降低移植术后体液性排斥和细胞性排斥的发生风险。Objective To evaluate the influence of desensitization pretreatment including double filtration plasmapheresis （DFPP） plus intravenous hnmunoglobulin （IVIG） and/or other inmmnosuppresants on panel reactive antibody （PRA） and clinical outcome in highly sensitized recipients waiting for living renal transplantation. Methods We observed 11 recipients with high PRA level （human leukocyte antigen class Ⅱ 〉 80% ） waiting for living renal transplantation in our institute. Five of them, as the experiment group, received DFPP 3 to 7 times and other treatments before transplantation. The titers of PRA before and after every DFPP were monitored by flow cytometry. The other six cases, as control group, received no pretreatment. The reject reaction and clinical effects were observed after transplantation. Results DEPP were performed 7 times on patient 1 and the PRA titers decreased obviously after the fifth DFPP. However, the PRA titers increased after the last 2 DFPP. In the other 4 recApients, the PRA titers decreased steadily after 3 to 5 times DFPP. There was no hyperaeute rejection （HAR） in all recipients. A cellular rejection episode occurred in 1 recipient （1/5） in experiment group, significantly less than that in control group （4/6）. Humoral rejections were observed in 3 recipients （3/6） in control group, obviously higher than that in experimental group. Conclusions The desensi- tization pretreatment can decrease the PRA titer in sensitized patients waiting for living renal transplantation and the incidence of humoral and cellular rejection episodes after transplantation.

关 键 词：双重滤过血浆置换 群体反应性抗体 流式细胞术 流式细胞术交叉配型 肾移植 

分 类 号：R699.2[医药卫生—泌尿科学]