血浆置换预防和治疗肾移植后加速及超急性排斥反应的观察

目的　探讨血浆置换疗法（PE）对预防和治疗肾移植后排斥反应的疗效。方法　选择30例肾移植前群体反应抗体（PRA）增高≥30%及10例肾移植后出现加速性排斥反应的患者，在用免疫抑制剂的同时作膜分离法血浆置换。结果　PE能清除各种免疫球蛋白及循环抗体,PE前后对比差异有显著性（P＜0.01），PE治疗后全部患者（30例）PRA≤10%，肾移植后经过6～9个月的观察，27例（占90%）未出现超急、加速或严重的急性排斥反应;10例肾移植后出现加速性排斥反应者，8例（占80%）逆转。结论　PE配合免疫抑制剂治疗，对预防和减轻肾移植后排斥反应疗效确切。

Plasma exchange preventing and treating acute-accelerated and hyperacute rejection after renal transplantation

Objective　To explore the therapeutic effects of plasma exchange (PE) for rejections after renal transplantation. Methods　PE was carried out on 30 patients whose population reactive antibodies (PRA) level was more than 30?% and 10 patients who suffered from acute-accelerated rejections after transplantation at the same time of administration of immunosupressants. Each of these patients accepted PE one time every two days, 3 000?ml each time, totally 2～4 times. Different indexes including immunoglobulins, complements and clinical manifestations were monitored before and after PE. Results　PE could cleared various immunoglobulins and circulatory antibodies with the difference being significant (P＜0.01). After PE, the high PRA was decreased to less than 10% in all patients and 8 of the 10 patients with acute-accelerated rejections reversed. During the follow-up of 6 to 9 months, 27 of the 30 cases with high PRA suffered neither hyperacute nor acute-accelerated, nor acute rejections. Conclusion　PE in combination with immunosupressants had a definitive therapeutic effect in the acute rejections following renal transplantation.