肾移植前对致敏患者干预治疗的方案及疗效分析  

Therapeutic options and efficacy analysis of sensitized renal transplant recipients

作　　者：陈栋[1,2] 张伟杰[1,2] 陈刚[1,2] 周平[1,2] 昌盛[1,2] 朱兰[1,2] 陈松[1,2] 施辉波[1,2] 杜敦峰[1,2] 陈知水[1,2] 

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 [2]教育部/卫生部器官移植重点实验室

出　　处：《中华器官移植杂志》2013年第4期202-205,共4页Chinese Journal of Organ Transplantation

摘　　要：目的总结和探讨肾移植前致敏患者干预治疗的方案及疗效分析。方法选择2008年至2011年接受肾移植的致敏受者43例，根据术前群体反应性抗体（PRA）水平分为轻度致敏组和高度致敏组，术前经血浆置换、输注静脉用免疫球蛋白（IVIG）的干预治疗，经过HLA配型，联合应用抗人胸腺细胞免疫球蛋白（ATG）诱导治疗，应用他克莫司（Tac）、吗替麦考酚酯（MMF）和泼尼松的免疫抑制方案，术后定期检测PRA水平。所有受者随访12-36个月，观察受者／移植肾存活率，急性排斥反应的发生率，移植肾功能和PRA水平的变化，以及进行移植肾穿刺活检。结果经干预治疗后，轻度致敏组中14例PRA完全转阴，高度致敏组中5例PRA完全转阴，其余受者PRA水平均较干预治疗前明显下降（P〈O．05）。术后两组受者均出现PRA水平的爬升。轻度致敏组和高度致敏组的人存活率分别为95．6％和90％，移植肾存’活l率分别为82．6％和70％。轻度致敏组有3例活检证实发生急性细胞性排斥反应，高度致敏组有5例活检证实发生急性排斥反应，急性细胞性排斥反应均经甲泼尼龙冲击治疗3～5d后逆转。两组共10例受者出现血肌酐缓慢爬升，经移植肾穿刺活检发现慢性移植肾肾病的表现。结论血浆置换和输注IVIG的干预治疗，良好的HLA配型，ATG诱导治疗，以及应用Tac＋MMF＋泼尼松的免疫抑制方案是致敏受者肾移植成功的前提。Objective To investigate the therapeutic options and effect of sensitized renal transplant recipients. Method Forty-three sensitized renal transplant patients in our hospital from 2008 to 2011 were enrolled in this study, and divided into mild sensitized group and highly sensitized group according to preoperative panel reactive antibody （PRA） levels. Therapeutic options included preoperative plasmapheresis, infusion of intravenous immunoglobulin （IVIG）, HLA typing, the application of anti-human thymocyte immune globulin （ATG） induction therapy, application of tacrolimus, mycophenolate mofetil, and prednisone immunosuppressive regimen. During the follow-up period of 12 to 36 months for all patients, patient/graft survival, incidence of acute rejection, renal function, PRA levels and transplant renal biopsy pathological changes were observed. Result After the intervention therapy, PRA level of 14 cases; in mild sensitized group and 5 in highly sensitized group completely became negative, and that of the remaining patients was significantly decreased （P〈0. 05） as compared with that before intervention. PRA levels in both groups were significantly increased after kidney transplantation. In mild sensitized group and highly sensitized group, survival rate of patients was 95.6% and 90%, and gratk survival rate was 82.6% and 70%, respectively. Acute cellular rejection was confirmed by renal allograft biopsy in 3 cases in mild sensitized group, and 5 cases in highly sensitized group. Acute cellular rejections were reversed by methylprednisolone therapy for 3 to 5 days. Ten patients with slowly climbing serum creatinine in both groups underwent renal allograft biopsy showing chronic allograft nephropathy. Conclusion Plasmapheresis, infusion IVIG, good HLA matching, ATG induction therapy, tacrolimus, mycophenolate mofetil, and prednisone immunosuppressive regimen were prerequisite for success kidney transplantation in sensitized patients.

关 键 词：致敏 肾移植 治疗方案 效果 

分 类 号：R699.2[医药卫生—泌尿科学]