第3次肾移植术治疗合并HLA抗体强阳性患者1例  

A case of nephrectomy with strong positive HLA antibody undergoing the third renal transplantation

作　　者：邓攀 张盛[1] 明英姿[1] 成柯[1] 王强[1] 叶啟发[1] 赵于军[1] DENG Pan;ZHANG Sheng;MING Yingzi;CHENG Ke;WANG Qiang;YE Qifa;ZHAO Yujun(Organ Transplantation Center,Third Xiangya Hospital,Central South University,Changsha 410013,China)

机构地区：[1]中南大学湘雅三医院器官移植中心,长沙410013

出　　处：《中南大学学报（医学版）》2019年第5期596-599,共4页Journal of Central South University ：Medical Science

基　　金：国家自然科学基金(81771722;81700658)~~

摘　　要：肾移植受者体内存在的人类白细胞抗原(human leukocyte antigen,HLA)抗体阳性既影响手术又易发生排斥反应,还能影响移植肾的长期存活。行第3次肾移植,双侧髂窝及髂血管均遭到破坏。由于粘连重、瘢痕形成多、容易损伤血管及肠管等,所以无论是手术血管的选取还是分离均非常困难。中南大学湘雅三医院收治1例HLA抗体强阳性,2次切除移植肾行第3次肾移植患者,术中成功处理移植空间少及血管疤痕粘连等问题,避开敏感位点,运用利妥昔单抗、兔抗人胸腺细胞免疫球蛋白及甲泼尼龙处理抗体,术后利用免疫功能检测制订个体化治疗方案等。术后患者肌酐、尿量趋向平稳,随访16个月移植肾功能良好。The positive human leukocyte antigen(HLA)antibody present in kidney transplant recipients affects both surgery and rejection,and also affects the long-term survival of the transplanted kidney.During the third kidney transplant,bilateral axillary fossa and iliac vessel were destroyed.It was very difficult for selection or separation of surgical vessels because the adhesions and scar formation was easy to damage blood vessels and intestinal tubes.A case with strong positive HLA antibody undergoing the third kidney transplant in our hospital was successfully solved the problems,such as less transplant space and vascular scar adhesion.Rituximab,rabbit anti-human thymocyte immunoglobulin,and methylprednisolone treated-antibodies were used in the operation.The immune function test was used to develop individualized treatment after the operation.The postoperative creatinine and urine volume tended to be stable,and the 16-month follow-up renal function was good.

关 键 词：移植肾切除 HLA抗体强阳性 第3次肾移植 预处理 排斥反应 

分 类 号：R699.2[医药卫生—泌尿科学]