ABOi肾移植O型受者围术期血型抗体变化分析  

Changes in blood type antibody of type-O recipients with ABO-incompatible kidney transplantation during perioperative period

作　　者：靳慧芳[1] 孔永奎[1] 刘欣[1] 王书亚 谢莹[1] 陈李影慧[1] 刘雪 刘爱萍[1] 杨乾坤[1] JIN Hui-fang;KONG Yong-kui;LIU Xin;WANG Shu-ya;XIE Ying;CHEN Li-ying-hui;LIU Xue;LIU Ai-ping;YANG Qian-kun(Department of Blood Transfusion,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院输血科,郑州450052

出　　处：《医药论坛杂志》2024年第15期1572-1577,1585,共7页Journal of Medical Forum

基　　金：河南省医学科技攻关计划项目(2018020026)。

摘　　要：目的分析ABO血型不相合肾移植(ABOi-KT)O型受者的围术期资料,探讨ABOi-KT受者血型抗体变化趋势。方法回顾性分析郑州大学第一附属医院2021年1月—2023年9月32例首次肾移植、血型O型受者的临床资料,依据供者血型不同,分为A供O组(n=17)和B供O组(n=15)。分析比较血浆置换对术前两组受者血型抗体的清除效果、术后两组血型抗体反弹和肾功能[术后第1、3、7、14天的尿素氮、肌酐和肾小球滤过率(estimated glomerular filtration rate,eGFR)]的差异。结果术前血浆置换对受者抗A-IgG抗体的清除率低于抗B-IgG抗体(Z=-2.238,P=0.025),而IgM抗体的清除率在两组间差异无统计学意义(Z=-1.911,P=0.056);A供O组术后更易出现血型抗体滴度反弹(P=0.018),但术后第1天、3天、7天、14天两组肾功指标差异均无统计学意义。结论与B供O组相比,A供O组ABOi-KT需要更加谨慎,因为围术期内抗A-IgG抗体清除相对困难且术后更易发生血型抗体滴度反弹。Objective To analyze the perioperative results in type-O recipients with ABOi-KT,to explore the changes in blood type antibody of ABO-incompatible kidney transplantation(ABOi-KT)patients.Methods From January 2021 to September 2023,clinical data of 32 cases of blood group O ABOi-KT recipients in our hospital were retrospectively analyzed,and patients were divided into two groups(A:n=17,B:n=15)according to the different blood types of donors.The effects of preoperative plasmapheresis on antibody titer,antibody rebound and renal function after operation(serum urea nitrogen,creatinine and estimated glomerular filtration rate on the 1st,3rd,7th and 14th day)were compared between the two groups.Results The clearance rate of anti-A IgG was lower than that of anti-B IgG(Z=-2.238,P=0.025),while no significant differences was found in clearance rate of Anti-A/B IgM between the two groups(Z=-1.911,P=0.056).There was no significant difference in levels of serum urea nitrogen,creatinine and eGFR at each observation point between the two groups(P>0.05).In addition,group A was more prone to rebound antibody when compared with group B(P=0.018).Conclusion ABOi-KT in group A required greater caution compared to the group B because of the lower clearance rate of anti-A IgG and the higher tendency of antibody rebound.

关 键 词：ABO血型不相合肾移植 血浆置换 抗体滴度 围术期 

分 类 号：R617[医药卫生—外科学]