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投稿时间：2021-07-09 网络发布日期：2021-11-20
投稿时间：2021-07-09 网络发布日期：2021-11-20
中文摘要: 目的 探讨ABO及Rh血型不相容的亲属肾移植受体个体化预处理方案，为血型不合的活体肾移植提供借鉴和依据。方法 以2020年7月至2021年3月安徽医科大学第一附属医院收治的9例ABO以及1例Rh血型不相容亲属肾移植受体为研究对象。受体术前均经过免疫抑制联合脱敏治疗及个体化预处理（利妥昔单抗+淋巴血浆置换），观察应用个体化预处理后淋巴细胞的变化，监测术前与术后血型抗体的滴度变化及肾功能恢复情况。结果 术前2周应用利妥昔单抗后外周血淋巴细胞计数及绝对值均明显下降低于正常值。受体采用血浆置换个体化预处理后，术前血型抗体IgM 、IgG 滴度及抗D效价均小于目标滴度。高血型抗体滴度（256）受体谨慎起见接受7次血浆置换，较低血型抗体滴度（≤128）受体平均接受2.5次血浆置换。预处理过程中，止凝血功能均正常；有6例受体出现皮疹，经异丙嗪治疗后迅速缓解，余受体无不良事件发生。术后有3例受体抗体滴度轻微反弹，血浆置换2次后迅速降低。术后30 d内除1例并发病毒感染肌酐下降缓慢，余9例包括Rh血型不合移植肾功能均稳定。结论 针对ABO及Rh血型不合活体肾移植，尽管术前抗体滴度高，采用个体化预处理方案，可以达到肾移植的要求，并且术后恢复良好。
Abstract: Objective To explore the individualized pretreatment plan for relative kidney transplant recipients with ABO-incompatible (ABOi) and Rh-incompatible (Rhi) living donor, so as to provide reference and basis for living donor kidney transplants with incompatible blood types. Methods From July 2020 to March 2021, 9 cases of ABOi and 1 case of Rhi living donor kidney transplantation admitted in the First Affiliated Hospital of Anhui Medical University was selected. Recipients received immunosuppression combined with desensitization therapy and individualized pretreatment (rituximab+lymph plasma exchange) before surgery. The changes of lymphocytes, blood group antibodies and the recovery of renal function were observed. Results The counts and absolute values of peripheral blood lymphocytes were significantly lower than normal value after treatment by rituximab 2 weeks before surgery. After individualized pretreatment of the recipient with plasma exchange, the preoperative blood group antibody IgM, IgG titers and anti-D titer were all less than the target titers. To be prudent, recipients with high blood group antibody titers (256) received 7 plasma exchanges. Recipients with lower blood group antibody titers (≤128) received an average of 2.5 plasma exchanges. During the pretreatment process, all the hemostatic functions of recipients were normal. Skin rashes occurred in 6 recipients, which were quickly resolved after promethazine treatment. No adverse events occurred in other recipients. Antibody titers rebounded slightly in 3 cases after surgery, which decreased rapidly after 2 replacements. Within 30 days after surgery, except for 1 case presented a slow decrease in creatinine level resulted from concurrent viral infection, the functions of grafted kidneys were stable in the remaining 9 cases including Rh-incompatibility. Conclusion Although the antibody titer is high before surgery, the use of individualized pretreatment program could meet the requirements of kidney transplantation in both of ABOi and Rhi living donor kidney transplantation, and achieve good recovery after surgery.
keywords: Kidney transplantation Lymphatic plasma exchange ABO-incompatible Rh-incompatible Rituximab Complication
文章编号： 中图分类号：R699.2 文献标志码：A
基金项目:国家自然科学基金青年基金（81801831）
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引用文本：
闻慧琴， 卫玉芝， 刘淑均， 刁玉洁， 程越， 卞茂红.利妥昔单抗联合淋巴血浆置换在ABO及Rh血型不合的活体肾移植中的应用[J].中国临床研究,2021,34(11):1482-1486,1490.
闻慧琴， 卫玉芝， 刘淑均， 刁玉洁， 程越， 卞茂红.利妥昔单抗联合淋巴血浆置换在ABO及Rh血型不合的活体肾移植中的应用[J].中国临床研究,2021,34(11):1482-1486,1490.