全身淋巴照射联合ATG在致敏患者肾移植及逆转AMR中的应用  

Application of combined TLI and low-dose ATG in highly sensitized or AMR renal allograft recipients..clinical practice and mechanism exploration

作　　者：李龙[1] 戚贵生 杨橙[1] 林淼[1] 赵梓彤 吴擘頲[3] 唐群业[1] 许明[1] 戎瑞明[1] 

机构地区：[1]复旦大学附属中山医院泌尿外科,上海200032 [2]上海市器官移植重点实验室 [3]复旦大学附属中山医院输血科

出　　处：《中华器官移植杂志》2013年第4期209-213,共5页Chinese Journal of Organ Transplantation

摘　　要：目的探讨全身淋巴照射联合抗胸腺细胞球蛋白（ATG）用于高致敏患者肾移植脱敏治疗及移植后抗体介导的排斥反应（AMR）治疗的效果。方法回顾性分析2009--2011年间13例肾移植受者的资料，其中2例为术前致敏患者，均接受全身淋巴照射＋血浆置换＋低剂量静脉注射丙种球蛋白（IVIG）＋ATG的脱敏方案；11例为经移植肾穿刺病理检查诊断的AMR，7例接受全身淋巴照射＋血浆置换＋低剂量IVIG＋ATG的治疗方案，4例接受全身淋巴照射＋IVIG＋ATG的治疗方案。结果术前脱敏治疗2例均治疗成功，并接受活体供肾移植，术后随访1年未出现病理证实的急性排斥反应，术后B淋巴细胞数量呈持续抑制趋势，随访期间未超过脱敏治疗前水平，术后各时间点调节性T淋巴细胞（Treg细胞）百分率较脱敏治疗前明显升高。术后AMR患者中，10例治疗后排斥反应成功逆转，1例因治疗失败行移植肾切除。治疗成功的AMR患者外周血B淋巴细胞比例及绝对数呈持续抑制趋势，neg细胞百分率较治疗前明显升高，治疗后1年行移植肾程序性活检均未发现AMR。结论全身淋巴照射联合ATG用于高致敏患者的脱敏治疗及肾移植受者AMR治疗，具有较好的临床效果，其机制可能与诱导Treg细胞的产生有关。Objective To explore the availability and safety of combined TLI and Low-dose ATG as desensitization protocol in highly sensitized or antibody-mediated rejection （AMR） renal allograft recipients and the potential mechanisms. Method Thirteen sensitized patients were enrolled in the study from 2009 to 2011. Their clinical data were collected. Two of 13 cases were defined as pre-transplantation sensitized group, who received combined therapy of TLI, PP, low-dose of IVIG, and ATG induction. Eleven cases were diagnosed as AMR proven by allograft biopsy： 7 cases received combined therapy of TLI, PP, low-dose IVIG, and ATG, and 4 cases were given combined therapy of TLI, low dose of IVIG, and ATG. Result Two pre-transplantation sensitized cases were successfully desensitized, and receive renal transplantation later. After desensitization, their peripheral B cell levels were persistently down-regulated, and the percentages of regulatory T cells were higher than those before desensitization at ＇several time points. For AMR cases, similar trends were observed except that only 1 case failed in the therapy and lost allograft. Renal allograft biopsy at 1 year checkpoint showed rio AMR in these cases successfully cured. Conclusion Combined therapy of TLI and low-dose ATG is an effective pathway for desensitization or AMR reversal. Further research demonstrated its effect on inducing Tregs.

关 键 词：肾移植 致敏 移植物排斥 抗体 淋巴照射 血浆置换 T淋巴细胞 调节 

分 类 号：R699.2[医药卫生—泌尿科学]