肾移植术后抗体介导的排斥反应治疗经验总结  

The experience of antibody mediated rejection therapy after kidney transplantation

作　　者：刘杰[1] 王建立 钱雷 邱爽 张庆 金海龙[1] 关兆杰 Liu Jie;Wang Jianli;Qian Lei;Qiu Shuang;Zhang Qing;Jin Hailong;Guan Zhaojie(Department of Organ Transplantation,Third Medical Center,General Hospital of the People's Liberation Army,Beijing 100039,China;Organ Transplantation Center of the Second Affiliated Hospital of Hainan Medical University,Hainan Haikou 570311,China;Organ Transplantation Center of Norman Bethune Hospital,Shanxi Taiyuan 030032,China)

机构地区：[1]解放军总医院第三医学中心器官移植科,北京100039 [2]海南医科大学附属第二医院器官移植中心,海南海口570311 [3]山西白求恩医院器官移植中心,太原030032

出　　处：《实用器官移植电子杂志》2024年第6期543-547,共5页Practical Journal of Organ Transplantation(Electronic Version)

基　　金：山西省自然科学研究面上项目(202203021211079)。

摘　　要：目的总结肾移植术后抗体介导的排斥反应(antibody mediated rejection,AMR)治疗经验。方法回顾性分析2018—2021年解放军总医院第三医学中心行肾移植术后经活检诊断为AMR的受者,治疗后规律随访并分析预后,对比移植后排斥反应发生的时间、病理类型、DSA种类、受者肾移植次数不同情况下,移植物的存活时间,初步筛选可能影响预后的因素。结果14例受者诊断为AMR,经过血浆置换、淋巴细胞清除性抗体及免疫球蛋白联合治疗,随访总体1年移植物生存率为78.6%,5年生存率为43%。治疗后6个月内出现需要入院治疗的感染3例,其中皮肤带状疱疹感染1例,尿路感染1例,腹泻1例。未出现与治疗直接相关的危及生命的感染。结论血浆置换为基础的联合方案治疗肾移植后抗体介导的排斥反应可取得一定的效果。针对不同类型排斥反应的优化方案尚需进一步研究。Objective To summarize the experience in the treatment of antibody mediated rejection(AMR)after kidney transplantation.Methods A retrospective analysis was conducted on kidney transplant recipients who was diagnosed as AMR by biopsy in the Third Medical Center of the General Hospital of the People's Liberation Army from 2018 to 2021.Regular follow-up and prognosis were analyzed after treatment.The survival time of the graft between different time of rejection after transplantation,pathological type,DSA type,and number of kidney transplants were compared,and factors that may affect prognosis were preliminarily screened.Results The results showed that 14 recipients were diagnosed with AMR.After combination therapy of plasma exchange,lymphocyte depleting antibody and immunoglobulin treatment,the overall 1-year graft survival rate was 78.6%,and the 5-year survival rate was 43%.Within 6 months after treatment,3 cases with infection required hospitalization,including 1 case of cutaneous herpes zoster infection,1 case of urinary tract infection,and 1 case of diarrhea.There were no life-threatening or graft loss case directly related to infection.Conclusion A combination treatment based on plasma exchange can achieve some effects in the treatment of antibody mediated rejection after kidney transplantation.Further research is needed on the optimization of protocols for different types of rejection.

关 键 词：肾移植 抗体介导排斥反应 利妥昔单抗 血浆置换 

分 类 号：R699.2[医药卫生—泌尿科学]