ABO血型不相容亲属活体肾移植的脱敏治疗  

Desensitization strategies for ABO-incompatible living related kidney transplantation

作　　者：邱江[1] 陈国栋[1] 阮和欢 邓灿[2] 李军[1] 邓素雄[1] 黄刚[1] 刘龙山[1] 傅茜[1] 王长希[1] 陈立中[1] Qiu Jiang;Chen Guodong;Ruan Hehuan;Deng Can;Li Jun;Deng Suxiong;Huang Gang;Liu Longshan;Fu Qian;Wang Changxi;Chen Lizhong(Department of Organ Transplantation, First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China;Department of Urology, Municipal People's Hospital, Gaozhou 525200, China)

机构地区：[1]中山大学附属第一医院器官移植科,广东广州510080 [2]高州市人民医院泌尿外科,广东高州525200

出　　处：《中华器官移植杂志》2019年第8期478-483,共6页Chinese Journal of Organ Transplantation

摘　　要：目的探讨ABO血型不相容(ABOi)亲属活体肾移植术前的脱敏治疗策略。方法回顾性分析2015年7月至2018年12月接受ABOi亲属活体肾移植的14例受者术前脱敏治疗方案,比较优化脱敏策略前后受者的临床结果及脱敏治疗费用。结果经脱敏治疗后,14例受者均顺利实施ABOi肾移植。术后2周内,1例受者血型抗体反弹至1:64,其余13例无反弹。术后1周内,14例受者的血肌酐水平均下降至85~165 μmol/L,其中13例均在1周后趋于平稳,1例在术后第12天左右血肌酐升高,经治疗后移植肾功能恢复。2例出现临床表现诊断的排斥反应,1例经病理活检证实;程序性移植肾穿刺病理活检,有5例1年内的病理结果显示为临界性或疑似急性T淋巴细胞性排斥反应;有13例(92.6%)出现不同程度的管周毛细血管C4d沉积。1例受者术后1年内发生BK病毒尿症,4例受者发生需住院治疗的肺部感染,经对症治疗后痊愈。早期阶段采用的脱敏方案术后感染发生率为57.14%,优化脱敏方案后感染发生率为14.29%。早期脱敏治疗方案费用为(27004.86±10719.85)元,优化后费用为(10612.29±8143.05)元,优化后的脱敏治疗费用显著降低(P<0.05)。随访期间,14例受者肾功能均保持良好,截至资料统计截点,受者和移植肾的存活率均为100%。结论两种脱敏策略均能达到脱敏目标以实施ABOi肾移植,且移植效果良好;方案优化后脱敏治疗费用显著降低。Objective To explore the strategies of desensitization treatment for ABO incompatible (ABOi) related living-donor kidney transplantation. Methods A retrospective analysis was performed for 14 recipients undergoing ABOi related living kidney transplantation from July 2015 to December 2018. The clinical outcomes and expenditures of desensitization treatment before and after optimizing desensitization were compared. Results After desensitization treatment, 14 recipients successfully underwent ABOi-kidney transplantation. Within 2 weeks post-transplantation, blood group antibody rebounded to 1: 64 in only 1 recipient. Within 1 week post-transplantation, the serum creatinine levels decreased to 85-165 μmol/L in 14 recipients. Thirteen patients stabilized after 1 week while another patient had an elevated level of serum creatinine at Day 12 post-operation and renal allograft function recovered after treatment. Two cases of rejection were diagnosed by clinical manifestations and 1 case was confirmed by pathological biopsy. Five cases of programmed renal allograft biopsy indicated critical or suspected acute T-lymphocytic rejection within 1 year. Thirteen cases (92.6%) demonstrated varying degrees of peritubular capillary deposition of C4d. One case developed BK viral uropathy within 1 year and four patients of pulmonary infections requiring hospitalization were cured after treatment. During an early stage, the incidence of postoperative infection was 57.14% and declined to 14.29% after optimized desensitization. The expenditure of early desensitization treatment was (27004.86±10719.85) yuan and (10612.29±8143.05) yuan after optimization. And the expenditure of optimized desensitization was significantly lowered (P<0.05). During follow-ups, renal allograft function of 14 recipients remained decent. And the survival rate of recipient/allograft was 100% up to the statistical cut-off point. Conclusions Both desensitization strategies may achieve the goal of desensitization for ABOi kidney transplantation and the outcomes

关 键 词：肾移植 活体供者 ABO血型不相容 血型抗体 脱敏治疗 抗体介导的排斥反应 

分 类 号：R699[医药卫生—泌尿科学]