双重膜滤过式血浆置换清除肾移植受者供体特异性抗体的临床观察  

Clinical observation on the removal of donor specific antibody by double filtration plasmapheresis in renal transplant recipients

作　　者：廖琪[1] 蒋秋艳 熊艳[1] 王凤英[1] 晏强[1] 邹贵勉[1] 眭维国[1] Liao Qi;Jiang Qiuyan;Xiong Yan;Wang Fengying;Yan Qiang;Zou Guimian;Sui Weiguo(Department of Nephrology, the 181＊t Hospital of People＇s Liberation Army, Organ Transplantation and Dialysis Treatment Center of People＇s Liberation Army, Guangxi Key Laboratory of Metabolic Disease Research, Guilin 541002, China)

机构地区：[1]解放军第181医院肾脏科全军器官移植与透析治疗中心广西代谢性疾病研究重点实验室,广西桂林541002

出　　处：《器官移植》2017年第6期455-459,共5页Organ Transplantation

基　　金：广西卫生厅计划课题(Z2013789)

摘　　要：目的探讨双重膜滤过式血浆置换(DFPP)对高致敏肾移植受者的供体特异性抗体(DSA)的清除效果。方法 4例肾移植高致敏受者共进行了7例次DFPP治疗,采用Luminex技术监测DSA的变化,观察治疗效果、急性排斥反应发生情况及其不良反应。结果治疗后DSA的MFI[1 036(0~4 113)]较治疗前[6 446(2 999~12 905)]明显下降(Z=-2.503,P=0.012)。4例高致敏肾移植受者均未发生超急性排斥反应,仅有1例发生急性排斥反应且通过术后DFPP治疗及调整免疫抑制剂得到逆转。受者随访至今移植肾功能良好,未发生排斥反应。DFPP治疗引起白蛋白水平下降。结论 DFPP可以有效清除受者体内的DSA,可以安全、有效地预防高致敏人群肾移植术后急性排斥反应。Objective To investigate the effect of double filtration plasmapheresis（DFPP） upon the removal of donor specific antibody（DSA） in highly sensitized recipients with renal transplantation. Methods Four highly sensitized recipients undergoing renal transplantation received 7 cycles of DFPP. Luminex technology was adopted to monitor the changes of DSA. Clinical efficacy, incidence of acute rejection and adverse reactions were observed. Results After DFPP, the DSA MFI [1 036（0-4 113）] was significantly declined than that before treatment [6 446（2 999-12 905）, Z=-2.503, P=0.012]. No hyperacute rejections occurred in four highly sensitized recipients undergoing renal transplantation. Acute rejection was noted in one case, which was mitigated by postoperative DFPP and adjustment of immunosuppressive agents. During postoperative follow-up, the function of transplant kidney was normal and no rejection reactions occurred. The level of albumin was decreased after DFPP. Conclusions DFPP can effectively remove the DSA in the recipients. It is an efficacious and safe approach to prevent the incidence of acute rejections in highly sensitized recipients after renal transplantation.

关 键 词：双重膜滤过式血浆置换 肾移植 供体特异性抗体(DSA) 受者 高致敏 抗体介导的排斥反应(AMR) Luminex技术 人类白细胞抗原(HLA)抗体 白蛋白 

分 类 号：R617[医药卫生—外科学] R392.4[医药卫生—临床医学]