脾脏放射治疗辅助清除肾移植后早期高水平供者特异性抗体1例  

assisted clearance of early high-level donor specific antibody after kidney transplantation through splenic radiotherapy:one case report

作　　者：郑旺 郭志良 萨如拉 赵光远 赵大强 朱兰[2] 陈刚[2] Zheng Wang;Guo Zhiliang;Sa Rula;Zhao Guangyuan;Zhao Daqiang;Zhu Lan;Chen Gang(Department of Organ transplantation,Changde Hospital,Xiangya School of Medicine,Central South University,Changde 415000,China;Institute of Organ Transplantation,Affiliated Tongji Hospital,Tongji Medical College,Huazhong University of Science&Technology,Key Laboratory of Organ Transplantation,Ministry of Education,Ministry of Public Health,Chinese Academy of Medical Sciences,Wuhan 430030,China)

机构地区：[1]中南大学湘雅医学院附属常德医院器官移植科,常德415000 [2]华中科技大学同济医学院附属同济医院器官移植研究所,教育部/国家卫生健康委员会/中国医学科学院器官移植重点实验室,武汉430030

出　　处：《中华器官移植杂志》2024年第2期122-124,共3页Chinese Journal of Organ Transplantation

摘　　要：本研究报道华中科技大学同济医学院附属同济医院收治的1例经术前血浆置换、静脉注射免疫球蛋白(intravenous immunoglobulins,IVIG)脱敏及免疫诱导治疗后行活体供肾肾移植的人类白细胞抗原预致敏受者,在术后早期临床诊断急性抗体介导的排斥反应(antibody mediated rejection,AMR),受者供者特异性抗体(donor specific antibody,DSA)大幅升高合并肾功能下降;血浆置换及IVIG降供者特异性抗体(donor specific antibody,DSA)治疗效果欠佳,但在行低剂量脾脏放射治疗后,DSA水平得到持续满意的下降,移植肾功能恢复正常。本例提示,在预致敏肾移植术后早期出现高水平DSA且常规治疗无效时,辅助低剂量脾照射可能是一个好选择。This report described one human leukocyte antigen pre-sensitized recipient undergoing preoperative plasmapheresis(PP),intravenous immunoglobulins(IVIG)desensitization and immune induction therapy before kidney transplantation with a donor kidney.Early postoperative clinical diagnosis was acute antibody-mediated rejection(AMR).A marked elevation of donor-specific antibodies(DSA)was accompanied by a decline of renal function.PP/IVIG dosing failed to lower the level of DSA.After low-dose splenic irradiation,DSA level dropped steadily and transplanted kidney function normalized.Thus adjuvant low-dose splenic irradiation may eliminate DSA immediately without a rebound.

关 键 词：肾移植 供者特异性抗体 脾脏放射治疗 抗体介导的排斥反应 

分 类 号：R699.2[医药卫生—泌尿科学]