ABO血型不相容亲属活体肾移植的多中心研究  

Preliminary results of multicenter studies on ABOincompatible kidney transplantation

作　　者：蒋鸿涛 李涛 任坤 于小华 王毅[1] 张善斌[1] 李德胜 甘惠玲 刘厚琴 徐亮 罗志刚 桂培根 谭湘芳 石炳毅[3] 蔡明[3] 李响[3] 徐俊楠 许亮 林涛 王显丁 刘洪涛[5] 张乐希 吴建永[6] 雷文华[6] 邱江[7] 陈国栋[7] 李军[7] 黄刚[7] 吴成林[7] 王长希[7] 陈立中[7] 陈正[8] 方佳丽[8] 张晓明[9] 门同义[9] 李现铎[9] 莫春柏[10] 王振[10] 史晓峰[10] 裴广辉[10] 涂金鹏 胡小鹏[11] 张晓东[11] 李宁 石韶华 陈花 王振兴 眭维国[14] 李盈[14] 晏强[14] 陈怀周[14] 赖柳生[14] 李金锋[15] 尚文俊[15] 丰贵文[15] 陈刚[16] 曾凡军[16] 朱兰 方军 戎瑞明[17] 王宣传 戚贵生[17] 王强[18] 田普训[19] 李杨[19] 田晓辉[19] 项和立[19] 潘晓鸣[19] 丁小明[19] 薛武军[19] 文吉秋[20] 徐小松[21] Jiang Hongtao;Li Tao;Ren Kun;Yu Xiaohua;Wang Yi;Zhang Shanbin;Li Desheng;Gan Huiling;Liu Houqin;Xu Liang;Luo Zhigang;Gui Peigen;Tan Xiangfang;Shi Bingyi;Cai Ming;Li Xiang;Xu Junnan;Xu Liang;Lin Tao;Wang Xianding;Liu Hongtao;Zhang Lexi;Wu Jianyong;Lei Wenhua;Qiu Jiang;Chen Guodong;Li Jun;Huang Gang;Wu Chenglin;Wang Changxi;Chen Lizhong;Chen Zheng;Fang Jiali;Zhang Xiaoming;Men Tongyi;Li Xianduo;Mo Chunbo;Wang Zhen;Shi Xiaofeng;Pei Guanghui;Tu Jinpeng;Hu Xiaopeng;Zhang Xiaodong;Li Ning;Shi Shaohua;Chen Hua;Wang Zhenxing;Sui Weiguo;Li Ying;Yan Qiang;Chen Huaizhou;Lai Liusheng;Li Jinfeng;Shang Wenjun;Feng Guiwen;Chen Gang;Zeng Fanjun;Zhu Lan;Fang Jun;Rong Ruiming;Wang Xuanchuan;Qi Guisheng;Wang Qiang;Tian Puxun;Li Yang;Tian Xiaohui;Xiang Heli;Pan Xiaoming;Ding Xiaoming;Xue Wujun;Wen Jiqiu;Xu Xiaosong(Second Affiliated Hospital of Hainan Medical University,Haikou 570311,China;Second Affiliated Hospital of University of South China,Hengyang 421001,China;8^th Medical Center of Chinese PLA General Hospital,Beijing 100036,China;West China Medical Center,Sichuan University,Chengdu 610041,China;Anhui Provincial Hospital,Hefei 230001,China;First Affiliated Hospital,College of Medicine,Zhejiang University,Hangzhou 310003,China;First Affiliated Hospital of Sun Yat sen University,Guangzhou 510080,China;Second Affiliated Hospital of Guangzhou Medical University,Guangzhou 510245,China;Shandong Provincial Qianfoshan Hospital,Jinan 250014,China;Tianjin First Central Hospital,Tianjin 300192,China;Beijing Chaoyang Hospital,Beijing 100020,China;Second People's Hospital of Shanxi Province,Taiyuan 030012,China;Shanxi Bethune Hospital,Taiyuan 030032,China;181^th PLA Hospital,Guilin 541002,China;First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Tongji Hospital,Tongji Medical Collage of Huazhong University of Science&Technology,Wuhan 430030,China;Zhongshan Hospital,Fudan University,Shanghai 200032,China;Beijing Friendship Hospital,Beijing 100050,China;First Affiliated Hospital of Xi'an Jiao Tong University,Xi'an 71006

机构地区：[1]海南医学院第二附属医院,海口570311 [2]南华大学附属第二医院,湖南衡阳421001 [3]中国人民解放军总院第八医学中心,北京100036 [4]四川大学华西医学中心,成都610041 [5]安徽省立医院,合肥230001 [6]浙江大学医学院附属第一医院,杭州310003 [7]中山大学附属第一医院,广州510080 [8]广州医科大学附属第二医院,510245 [9]山东省千佛山医院,济南250014 [10]天津市第一中心医院,300192 [11]首都医科大学附属北京朝阳医院,100020 [12]山西省第二人民医院,大原030012 [13]山西白求恩医院,太原030032 [14]解放军第一八一医院,桂林541002 [15]郑州大学第一附属医院,郑州450052 [16]华中科技大学同济医学院同济医院,武汉430030 [17]复旦大学附属中山医院,上海200032 [18]首都医科大学附属北京友谊医院,100050 [19]西安交通大学附属第一医院,西安710061 [20]中国人民解放军东部战区总医院,南京210002 [21]陆军军医大学附属第一医院,重庆400038

出　　处：《中华器官移植杂志》2020年第5期259-264,共6页Chinese Journal of Organ Transplantation

基　　金：海南省科技厅重大科技计划项目(ZDKT2019009);急救与创伤研究教育部重点实验室开放基金(KLET-201919);海南医学院第二附属医院院内人才引进科研启动基金(KYQDJ-2018-02,KYQDJ-2019-03)。

摘　　要：目的总结19家移植中心已开展ABO血型不相容亲属活体肾移植(ABOi-KT)的临床效果,为临床开展ABOi-KT提供可借鉴经验。方法收集2006年12月至2019年12月各中心已开展ABOi-KT和同期ABO血型相容亲属活体肾移植(ABOc-KT)的临床资料,从组织配型、术前处理方案、术后并发症、移植物及受者存活率方面进行统计分析,评估国内现阶段ABOi-KT的效果。结果342例ABOi组和779例ABOc组供、受者相比,(1)年龄、体重指数、供受者关系及术前透析等待时间等没有显著差别;(2)ABO血型:各移植中心O型受者等待名单最长,实施O型受者ABOi-KT,特别是A型给O型的比例最高;(3)HLA配型:两种手术在错配率、群体反应性抗体(PRA)I类、PARⅡ类的阳性率无明显差异;(4)术前抗CD20单抗的使用根据不同时期应用方案不同;(5)外科并发症:开展ABOi-KT的早期以出血最为常见,现阶段可见血管内微血栓形成,与ABOc-KT相比,并发症发生率并无显著性差异;(6)术后1、3、5、10年移植肾存活率和受者存活率均较高,1年内急性排斥反应(AR)发生率和血肌酐水平较低,与ABOc-KT相当。结论ABOi-KT技术成熟、安全有效,各移植中心可根据需要开展。Objective To summarize the patient profiles and therapeutic efficacies of ABO-incompatible living-related kidney transplantations at 19 domestic transplant centers and provide rationales for clinical application of ABOi-KT.Methods Clinical cases of ABO-incompatible/compatible kidney transplantation(ABOi-KT/ABOc-KT)from December 2006 to December 2009 were collected.Then,statistical analyses were conducted from the aspects of tissue matching,perioperative managements,complications and survival rates of renal allograft or recipients.Results Clinical data of 342 ABOi-KT and 779 ABOc-KT indicated that(1)no inter-group differences existed in age,body mass index(BMI),donor-recipient relationship or waiting time of pre-operative dialysis;(2)ABO blood type:blood type O recipients had the longest waiting list and transplantations from blood type A to blood type O accounted for the largest proportion;(3)HLA matching:no statistical significance existed in mismatch rate or positive rate of PRA I/II between two types of surgery;(4)CD20 should be properly used on the basis of different phrases;(5)hemorrhage was a common complication during an early postoperative period and microthrombosis appeared later;(6)no difference existed in postoperative incidence of complications or survival rate of renal allograft and recipients at 1/3/5/10 years between ABOi-KT and ABOc-KT.The acute rejection rate and serum creatinine levels of ABOi-KT recipients were comparable to those of ABOc-KT recipients within 1 year.Conclusions ABOi-KT is both safe and effective so that it may be applied at all transplant centers as needed.

关 键 词：肾移植 ABO血型 不相容 预后 

分 类 号：R699.2[医药卫生—泌尿科学]