利妥昔单抗联合淋巴血浆置换在ABO及Rh血型不合的活体肾移植中的应用  

Application of rituximab combined with lymphatic plasma exchange in ABO-incompatible and Rh-incompatible living donor kidney transplantation

作　　者：闻慧琴[1] 卫玉芝[1] 刘淑均[1] 刁玉洁 程越[1] 卞茂红[1] WEN Hui-qin;WEI Yu-zhi;LIU Shu-jun;DIAO Yu-jie;CHENG Yue;BIAN Mao-hong(Department of Blood Transfusion,The First Affiliated Hospital of Anhui Medical University,Hefei,Anhui 230022,China)

机构地区：[1]安徽医科大学第一附属医院输血科,安徽合肥230022

出　　处：《中国临床研究》2021年第11期1482-1486,1490,共6页Chinese Journal of Clinical Research

基　　金：国家自然科学基金青年基金(81801831)。

摘　　要：目的探讨ABO及Rh血型不相容的亲属肾移植受体个体化预处理方案,为血型不合的活体肾移植提供借鉴和依据。方法以2020年7月至2021年3月安徽医科大学第一附属医院收治的9例ABO以及1例Rh血型不相容亲属肾移植受体为研究对象。受体术前均经过免疫抑制联合脱敏治疗及个体化预处理(利妥昔单抗+淋巴血浆置换),观察应用个体化预处理后淋巴细胞的变化,监测术前与术后血型抗体的滴度变化及肾功能恢复情况。结果术前2周应用利妥昔单抗后外周血淋巴细胞计数及绝对值均明显下降低于正常值。受体采用血浆置换个体化预处理后,术前血型抗体IgM、IgG滴度及抗D效价均小于目标滴度。高血型抗体滴度(256)受体谨慎起见接受7次血浆置换,较低血型抗体滴度(≤128)受体平均接受2.5次血浆置换。预处理过程中,止凝血功能均正常;有6例受体出现皮疹,经异丙嗪治疗后迅速缓解,余受体无不良事件发生。术后有3例受体抗体滴度轻微反弹,血浆置换2次后迅速降低。术后30 d内除1例并发病毒感染肌酐下降缓慢,余9例包括Rh血型不合移植肾功能均稳定。结论针对ABO及Rh血型不合活体肾移植,尽管术前抗体滴度高,采用个体化预处理方案,可以达到肾移植的要求,并且术后恢复良好。Objective To explore the individualized pretreatment plan for relative kidney transplant recipients with ABO-incompatible(ABOi)and Rh-incompatible(Rhi)living donor,so as to provide reference and basis for living donor kidney transplants with incompatible blood types.Methods From July 2020 to March 2021,9 cases of ABOi and 1 case of Rhi living donor kidney transplantation admitted in the First Affiliated Hospital of Anhui Medical University was selected.Recipients received immunosuppression combined with desensitization therapy and individualized pretreatment(rituximab+lymph plasma exchange)before surgery.The changes of lymphocytes,blood group antibodies and the recovery of renal function were observed.Results The counts and absolute values of peripheral blood lymphocytes were significantly lower than normal value after treatment by rituximab 2 weeks before surgery.After individualized pretreatment of the recipient with plasma exchange,the preoperative blood group antibody IgM,IgG titers and anti-D titer were all less than the target titers.To be prudent,recipients with high blood group antibody titers(256)received 7 plasma exchanges.Recipients with lower blood group antibody titers(≤128)received an average of 2.5 plasma exchanges.During the pretreatment process,all the hemostatic functions of recipients were normal.Skin rashes occurred in 6 recipients,which were quickly resolved after promethazine treatment.No adverse events occurred in other recipients.Antibody titers rebounded slightly in 3 cases after surgery,which decreased rapidly after 2 replacements.Within 30 days after surgery,except for 1 case presented a slow decrease in creatinine level resulted from concurrent viral infection,the functions of grafted kidneys were stable in the remaining 9 cases including Rh-incompatibility.Conclusion Although the antibody titer is high before surgery,the use of individualized pretreatment program could meet the requirements of kidney transplantation in both of ABOi and Rhi living donor kidney transplantation,and ach

关 键 词：肾移植 淋巴血浆置换 ABO血型不相容 Rh血型不相容 利妥昔单抗 并发症 

分 类 号：R699.2[医药卫生—泌尿科学]