血浆置换与免疫球蛋白高敏受者脱敏治疗肾移植

背景：高敏受者肾移植前应用静脉注射免疫球蛋白尚无统一方案,而国内应用较少。目的：探讨采用血浆置换联合静脉注射免疫球蛋白干预的方法,对肾移植高敏受者进行脱敏治疗的可行性及效果分析。方法：28例肾移植患者进行人类白细胞抗原交叉配型,并进行脱敏及血浆置换联合静脉注射免疫球蛋白,观察排斥反应发生率和移植肾存活时间及功能。结果与结论：28例脱敏患者均未发生超急性排斥反应,9例（32%）发生急性排斥反应,其中5例（18%）为急性体液性排斥,所有排斥反应均逆转。平均随访（50±24）个月,移植后1和2年平均血肌酐分别为（112.18±17.20）和（129.78±36.52）μmol/L。移植肾12和48个月年存活率分别为95.0%和78.0%。提示采用血浆置换联合静脉注射免疫球蛋白能有效地对高敏受者进行脱敏治疗,移植后急性体液性排斥发生率高是该方案的主要问题,随访表明近期效果可以,远期效果有待观察。

Desensitization of highly sensitized renal transplant recipients by plasmapheresis and intravenous immunoglobulin

BACKGROUND： As there is no unified program about intravenous immunoglobulin in highly sensitized renal transplant recipients before transplantation, so it is not widely used in domestic. OBJECTIVE： To evaluate the feasibility and efficacy of plasmapheresis plus low-dose intravenous immunoglobulin for the desensitization therapy of highly sensitized renal transplant recipients. METHODS： Twenty-eight cases of renal transplant patients performed with human leukocyte antigen crossmatch and received plasmapheresis plus intravenous immunoglobulin, and then the rejection rate, graft survival time and functions of the transplanted kidney were observed. RESULTS AND CONCLUSION： In desensitization group, no hyperacute acute occurred in the 28 desensitization patients. There were nine （32%） cases of acute rejection, including five （18%） cases of acute humoral rejection. All rejection episodes were reversed. With a follow-up of （50±24） months, the serum creatinine levels at 12 and 24 months were （112±18） μmol/L and （130±38） μmol/L, respectively. The survival rate at 12 and 48 months was 95.0% and 78.0% respectively. The desensitization therapy by plasmapheresis plus intravenous immunoglobulin is effective for highly sensitized renal transplant recipients. High rate of acute humoral rejection is the major defect of this protocol. The short-term graft survival rate after this protocol is acceptable but the long-term survival rate needs to be defined.