ABO血型不相容亲属活体肾移植23例报告  

ABO-incompatible living-related kidney transplantation:report of 23 cases

作　　者：史晓峰[1] 窦古枫 杜青 郭丽平 王振[1] 赵杰[1] 冯钢[1] 莫春柏[1] Shi Xiaofeng;Dou Gufeng;Du Qing;Guo Liping;Wang Zhen;Zhao Jie;Feng Gang;Mo Chunbai(Department of Kidney Transplantation,Tianjin First Central Hospital,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院肾移植科,天津300192

出　　处：《器官移植》2023年第6期831-837,共7页Organ Transplantation

基　　金：天津市卫生健康委员会科技项目(KJ20128)。

摘　　要：目的探讨ABO血型不相容(ABOi)亲属活体肾移植的临床疗效和安全性。方法回顾性分析23例ABOi亲属活体肾移植受者的临床资料。术前根据受者的初始血型抗体滴度,采取不同的个体化预处理方案,包括口服免疫抑制药+利妥昔单抗,或口服免疫抑制药+血浆置换和(或)血浆双重滤过+利妥昔单抗等,监测预处理前、后,肾移植术前及术后的血型抗体滴度和围手术期移植肾功能、相关并发症。并随访移植肾功能及相关并发症。结果23例ABOi亲属活体肾移植受者中,除1例术中出现超急性排斥反应,其余22例血清肌酐水平恢复良好。围手术期并发症包括4例淋巴瘘、1例尿瘘、1例肾周血肿合并T细胞介导的排斥反应、6例泌尿系统感染、1例急性肾小管坏死、1例急性胰腺炎、1例血型抗体反弹、1例原发病复发,经治疗均痊愈。截止至随访日,22例受者的移植物和受者存活率均为100%,移植肾功能良好。随访期间血型抗体滴度均≤1∶8。随访期并发症包括2例严重肺部感染、1例抗体介导的排斥反应、2例原发病复发、1例淋巴囊肿、1例泌尿系统感染、1例带状疱疹、1例BK病毒尿症和2例血糖异常。结论根据不同血型抗体水平选择个体化预处理方案,可以安全地实施ABOi亲体肾移植。但大剂量使用利妥昔单抗,或在高致敏受者中联合使用兔抗人胸腺细胞免疫球蛋白诱导,均可能出现严重的感染并发症。Objective To evaluate clinical efficacy and safety of ABO-incompatible(ABOi)living-related kidney transplantation.Methods Clinical data of 23 recipients undergoing ABOi living-related kidney transplantation were retrospectively analyzed.According to the initial blood group antibody titers in the recipients before surgery,different individualized pretreatment regimens were adopted,including oral intake of immunosuppressive drugs plus rituximab,or oral intake of immunosuppressive drugs plus plasma exchange and/or double filtration plasmapheresis plus rituximab.The blood group antibody titers before and after pretreatment,before and after kidney transplantation,and perioperative renal function and related complications were monitored.Renal allograft function and related complications were observed during postoperative follow-up.Results Among 23 recipients undergoing ABOi living-related kidney transplantation,except for one case presenting with hyperacute rejection during operation,the serum creatinine levels of the remaining 22 recipients were restored normal.Perioperative complications included lymphatic fistula in 4 cases,1 case of urinary fistula,1 case of perirenal hematoma complicated with T cell-mediated rejection,6 cases of urinary system infection,1 case of acute tubular necrosis,1 case of acute pancreatitis,1 case of blood group antibody titer rebound,and 1 case of primary disease recurrence,and all of these complications were cured after corresponding treatment.During postoperative follow-up,the graft and recipient survival rates of 22 recipients were 100%,and renal allograft function was normal.The blood group antibody titer were all≤1:8 during follow-up.Complications during follow-up included 2 cases of severe lung infection,1 case of antibody-mediated rejection,2 cases of primary disease recurrence,1 case of lymphocyst,1 case of urinary system infection,1 case of herpes zoster,1 case of BK viruria and 2 cases of abnormal blood glucose levels.Conclusions ABOi living-related kidney transplantation may b

关 键 词：肾移植 ABO血型不相容 活体供者 血型抗体 血浆置换 利妥昔单抗 兔抗人胸腺细胞免疫球蛋白 超急性排斥反应 

分 类 号：R617[医药卫生—外科学] R392.4[医药卫生—临床医学]