ABO血型不相合肾移植预处理对受者免疫状态及移植效果的影响  

Impact of preconditioning in ABO incompatible kidney transplantation on immune status and outcome of recipients

作　　者：王显丁[1] 吕远航 黄霞[2] 李亚梅 石运莹[4] 范钰[1] 宋涂润[1] 黄中力[1] 冯师健 王志灵 王莉[1] 林涛[1] Wang Xianding;Lv Yuanhang;Huang Xia;Li Yamei;Shi Yunying;Fan Yu;Song Turun;Huang Zhongli;Feng Shijian;Wang Zhiling;Wang Li;Lin Tao(Department of Urology,Institute of Urology,Organ Transplantation Center,West China Hospital,Sichuan University,Chengdu 610041,China;The Third Comprehensive Care Unit,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Laboratory Medicine,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Nephrology,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院泌尿外科泌尿外科研究所器官移植中心,成都610041 [2]四川大学华西医院第三综合病房,成都610041 [3]四川大学华西医院实验医学科,成都610041 [4]四川大学华西医院肾脏内科,成都610041

出　　处：《中华器官移植杂志》2019年第12期717-722,共6页Chinese Journal of Organ Transplantation

基　　金：国家自然科学基金(81470980、81870513、81600584);四川省科技计划项目(2019YJ0133);四川大学青年教师科研启动基金(2017SCU11022);四川大学华西医院学科卓越发展1·3·5工程(ZY2016104、ZYJC18004);临床研究孵化项目(2018HXFH049)。

摘　　要：目的探讨ABO血型不相合亲属活体肾移植(ABO incompatible kidney transplant,ABOiKT)受者外周血淋巴细胞及免疫分子的变化。方法本研究纳入ABOiKT受者26例和血型相合肾移植(ABO compatible kidney transplant,ABOcKT)受者58例,根据预处理方案分为三组:使用利妥昔单抗组(RTX组)、未使用利妥昔单抗组(noRTX组)和血型相合肾移植组(ABOc组),比较三组受者预处理前后及移植前后外周血T、B淋巴细胞、细胞因子、免疫球蛋白和补体的水平,及肾功能、存活率、排斥反应和感染发生率。结果三组受者T细胞计数无统计学差异;术后6个月内RTX组受者B细胞均低于ABOc组;三组受者术后免疫球蛋白的统计学差异在1个月后均消失。术后补体、细胞因子水平和肾功能差异无统计学意义,未见移植肾功能丧失或者受者死亡。结论ABOi肾移植及其预处理显著减少B淋巴细胞计数,但没有改变T淋巴细胞、补体及细胞因子水平,免疫球蛋白的差异也可在移植后1个月消失。ABOiKT与ABOcKT相比具有相近的移植效果和安全性。Objective To explore the changes of lymphocytes and immune molecules in peripheral blood of ABO incompatible kidney transplant(ABOiKT)recipients.Methods The recipients were ABOiKT(n=26)and ABO compatible kidney transplant(ABOcKT,n=58).They were divided into three groups of using rituximab(RTX),using no rituximab(noRTX)and ABOc.T/B cells,cytokines,immunoglobulin and complement levels in peripheral blood,renal function,survival rate and incidence of rejection and infection were compared among these groups.Results No significant difference existed in T cell count of peripheral blood among three groups.B cell count was significantly lower in RTX group than ABOc group within 6 months post-transplantation.The difference of immunoglobulin levels among three groups disappeared at 1 month postoperatively.The postoperative levels of complement or cytokine and renal function showed almost no difference among these groups.There was no graft loss or recipient death.Conclusions ABOiKT plus preconditioning regimens significantly lower B cell count.However,there is no significant change of T lymphocyte,complements or cytokines.And differences in immunoglobulin disappear after 1 month.As compared with ABOcKT,ABOiKT offers comparable safety.

关 键 词：肾移植 ABO血型 预处理 免疫 

分 类 号：R699[医药卫生—泌尿科学]