ABO血型不相容活体肾移植经验分析  

Experience analysis of ABO-incompatible live kidney transplantation

作　　者：赵美姗 朱一辰[1] 田野[1] Zhao Meishan;Zhu Yichen;Tian Ye(Department of Urology,Beijing Friendship hospital,Capital Medical University,Institute of Urology,Beijing Municipal Health Commission,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院泌尿外科,北京市卫生健康委员会泌尿外科研究所,北京100050

出　　处：《实用器官移植电子杂志》2024年第5期394-399,共6页Practical Journal of Organ Transplantation(Electronic Version)

摘　　要：目的终末期肾病患者的器官需求和供应之间存在着巨大的差距。为了增加供肾数量,肾脏移植正在试图突破ABO和人类白细胞抗原(human leukocyte antigen,HLA)不相容屏障进行。ABO血型不合的肾移植(ABO-incompatible kidney transplantation,ABOi-KT)受者发生抗体介导的排斥反应、感染和死亡的风险均增加。本文在ABOi-KT受体的手术前使用血浆置换和利妥昔单抗诱导脱敏治疗,目的为降低排斥反应发生率,并提高移植物以及患者生存率。方法纳入首都医科大学附属北京友谊医院2020—2023年接受ABOi肾移植的所有受者。受者术前均接受了利妥昔单抗和血浆置换治疗,并在每次血浆置换后测定ABO抗体效价。移植前静脉注射甲基强的松龙作为诱导治疗。口服泼尼松、霉酚酸酯和他克莫司作为维持治疗。结果共进行了6例ABOi-KT,受试者平均随访时间为412 d。1例患者罹患肺炎克雷伯菌和光滑假丝酵母菌感染,抗细菌及真菌治疗后痊愈,6例患者未罹患BK病毒、巨细胞病毒、单纯疱疹病毒感染。1例患者术后出现移植肾漏尿并进行移植肾输尿管膀胱再吻合术。移植物和患者的1年生存率均为100%。结论在本中心的ABOi-KT中,观察到感染并发症的风险较低,移植物及患者存活率良好。Objective There is a huge gap between organ demand and supply for patients with end-stage renal disease.To increase the supply of kidneys,kidney transplantation is trying to break through ABO and human leukocyte antigen(HLA)incompatible barriers.ABO-incompatible kidney transplantation(ABOi-KT)increases the risk of antibody-mediated rejection,infection and death in recipients.We use plasma exchange and rituximab desensitization therapy before surgery in ABOi-KT recipients to reduce the incidence of rejection and improve graft and patient survival.Methods All recipients undergoing ABOi kidney transplantation in our center from 2020 to 2023 were included.Recipients underwent rituximab and plasma exchange therapy preoperatively,and ABO antibody titers were measured after each plasma exchange.Intravenous methylprednisolone was administered as induction therapy before transplantation.Oral prednisone,mycophenolate and tacrolimus were used as maintenance therapy.Results A total of 6 cases of ABOi-KT were performed with an average follow-up of 412 days.One patient suffered from Klebsiella pneumoniae and Candida glabrata infection,and was cured after anti-bacterial and anti-fungal treatment.None of the 6 patients suffered from BK virus,cytomegalovirus,or herpes simplex virus infection.One patient had post-operative urine leakage from the graft kidney and underwent re-anastomosis of the transplanted ureter and bladder.The 1-year graft and patient survival rates were all 100%.Conclusion In our center's ABOi-KT,the risk of infectious complications was low,and graft and patient survival were good.

关 键 词：ABO血型不相容肾移植 血浆置换 利妥昔单抗 术后感染 

分 类 号：R699.2[医药卫生—泌尿科学]