ABO血型不相容肾移植中高抗体滴度O型受者采用供者同型血浆预处理的初步探索  

Application of plasma with same blood group as kidney donor to preconditioning of ABO incompatible kidney transplantation

作　　者：戴帅 王敏[2] 荆亚楠 方慢 管晓红 汤志勇 王克儒 刘洪涛 Dai Shuai;Wang Min;Jing Yanan;Fang Man;Guan Xiaohong;Tang Zhiyong;Wang Keru;Liu Hongtao(Department of Kidney Transplantation,The First Affiliated Hospital of VSTC,Divosion of Life Science and Medicine,University of Science&Technology of China,Hefei 230036,China)

机构地区：[1]中国科学技术大学附属第一医院(安徽省立医院)肾移植科,合肥230036 [2]中国科学技术大学附属第一医院(安徽省立医院)输血科,合肥230036

出　　处：《中华器官移植杂志》2022年第7期385-389,共5页Chinese Journal of Organ Transplantation

摘　　要：目的探讨ABO血型不相容肾移植(ABO-incompatible kidney transplantation,ABOi-KT)中的O型受者采用供者同型血浆置换进行预处理的可行性和安全性。方法回顾性分析2021年1月至2021年11月中国科学技术大学附属第一医院肾移植科收治的15例O型ABOi-KT受者预处理过程和术后3个月内的临床资料。按术前预处理过程中血浆置换采用的血浆类型分为AB型组(8例)和供者同型组(7例),采用秩和检验比较两组受者血浆去除治疗(plasmapheresis,PP)次数以及血型抗体滴度,采用t检验比较两组受者PP频率和术后血肌酐值。结果15例受者均预存高滴度血型抗体(IgM或IgG滴度≥1∶256)。预处理过程行PP(8.1±2.5)次,其中双重血浆滤过(4.0±1.4)次,血浆置换(4.1±2.0)次,PP频率为(0.8±0.1)次/d。供者同型组受者行供者同型血浆置换3~4次,共计24次,置换过程中未发生溶血等特殊副反应。两组受者血型抗体滴度经预处理后均达到ABOi-KT手术标准(IgM和IgG滴度均≤1∶8)并顺利手术。15例受者术后未发生血型抗体介导的排斥反应,移植肾功能良好。术后7 d、30 d和90 d,血肌酐值分别为(92.9±30.4)μmol/L、(96.2±25.9)μmol/L和(103.1±28.4)μmol/L,血型抗体IgM滴度分别为1∶1~1∶32、1∶1~1∶64、1∶1~1∶32,血型抗体IgG滴度分别为1∶1~1∶64、1∶1~1∶64、1∶1~1∶32。供者同型组与AB型组预处理中PP次数和频率以及各观察点血型抗体滴度和血肌酐水平比较,差异均无统计学意义(均P>0.05)。结论在ABOi-KT预处理中采用供者同型血浆置换是安全可行的,其对预存高滴度血型抗体的O型受者预处理效果良好,且能够保障手术安全和移植效果,但潜在风险和远期效果仍需进一步探究。Objective To explore the feasibility of applying plasma with same blood group as kidney donor to ABO incompatible kidney transplantation(ABOi-KT)preconditioning of blood group O recipients with high-titer anti-A/B preformed antibody(IgM/IgG titer≥1∶256).Methods A total of 15 cases of blood group O ABOi-KT recipients with high-titer anti-A/B were recruited and divided into two groups of AB(n=8)and kidney donor's blood(KD,n=7)according to plasma type for plasma exchange during preconditioning phase.Clinical data of preconditioning and post-KT were recorded.Results They received plasmapheresis(PP)(8.1±2.5)sessions in preconditioning phase,including double plasma filtration(DFPP)(4.0±1.4)sessions and plasma exchange(PE)(4.1±2.0)sessions,PP frequency was(0.8±0.1)sessions per day.No hemolysis reaction occurred during preconditioning phase.Anti-A/B titers declined as expected and fulfilled the ABOi-KT criteria(IgM/IgG titers≤1∶8).KT was performed successfully without antibody-mediated rejection.All of them survived with normal renal function within 90 days post-KT.Levels of serum creatinine at Day 7/30/90 post-KT were(92.9±30.4),(96.2±25.9)and(103.1±28.4)μmol/L;anti-A/B IgM titers at Day 7/30/90 post-KT 1∶1-1∶32,1∶1-1∶64 and 1∶1-1∶32;anti-A/B IgG titers at Day 7/30/90 post-KT 1∶1-1∶64,1∶1-1∶64 and 1∶1-1∶32 respectively.No significant differences existed in count/frequency of PP sessions,levels of serum creatinine or anti-A/B titers at each observation point between AB and KD groups(P>0.05).Conclusions Plasma with the same blood group as kidney donor is feasible for maximizing the intensity of ABOi-KT preconditioning.Favorable outcomes may be achieved through an intensified desensitization strategy on blood group O recipients with high-titer anti-A/B preformed antibody.The potential risks and long-term outcomes should be further explored.

关 键 词：肾移植 ABO血型不相容肾移植 血浆置换 对比研究 

分 类 号：R699.2[医药卫生—泌尿科学]