初始血型抗体效价水平对ABO血型不相合活体肾移植受体肾功能及免疫功能的影响

Effect of initial blood group antibody titer on renal function and immune function in ABO blood typeincompatible live renal transplant receptors

目的探讨ABO血型不相合活体肾移植受体肾移植术前初始血型抗体效价水平对术后肾功能及免疫功能的影响。方法选取2019年7月至2021年6月安徽省立医院接受活体肾移植的患者91例,所有肾移植供、受者ABO血型均不相合,根据患者入院时血型抗体免疫球蛋白M(IgM)效价水平分为高效价组(IgM≥128)和低效价组(IgM<128),所有患者术前均采用双重血浆滤过免疫抑制后进行活体肾移植手术,观察比较2组患者术后血型抗体、肾功能、细胞免疫、体液免疫的变化。结果2组患者术后第1天、术后第3天、术后第7天及出院时各时点间、组间的血型抗体IgM、IgG效价水平差异无统计学意义(P>0.05);2组肌酐比较,2组术后第3天、术后第7天、出院时明显低于术后第1天(P<0.05);2组肾小球滤过率水平比较,2组术后第3天、术后第7天、出院时明显高于术后第1天(P<0.05),高效价组与低效价组差异无统计学意义(P>0.05);2组CD3、CD4、CD4/CD8、NK细胞水平比较,术后第7天、出院时明显高于术后第1天,出院时明显高于术后第3天(P<0.05),高效价组与低效价组比较,差异无统计学意义(P>0.05);2组IgG、IgA、IgM、C3、C4水平比较,术后第7天、出院时明显高于术后第1天,出院时明显高于术后第3天,出院时高效价组明显高于低效价组(P<0.05)。结论ABO血型不相合活体肾移植受体初始血型抗体效价水平对患者的肾功能、细胞免疫功能无显著影响,但高效价水平患者的体液免疫水平术后更高。

Objective To investigate the effect of the initial blood group antibody titer before renal transplantation on the postoperative renal function and immune function in ABO blood type-incompatible living donor kidney transplant recipients.Methods A total of 91 patients who received living donor kidney transplantation at Anhui Provincial Hospital from July 2019 to June 2021 were selected.ABO blood types were incompatible between all kidney transplant donors and recipients.According to the blood group antibody immunoglobulin(Ig)M titer levels of the patients at admission,they were divided into either a high titer group(IgM≥128)or a low titer group(IgM<128).All patients were treated by double filtration plasmapheresis before surgery and then underwent living donor kidney transplantation.Changes of blood group antibody,renal function,cellular immunity,and humoral immunity after operation were compared between the two groups.Results There was no significant difference in the levels of blood group antibody IgM or IgG titers at days 1,3,and 7 after operation,and at the time of discharge between the two groups(P>0.05).Creatinine at days 3 and 7 and at discharge were significantly lower than that at day 1 in both groups(P<0.05),while glomerular filtration rate at days 3 and 7 and at discharge were significantly higher than that at day 1(P<0.05);there was no statistical difference between the two groups(P>0.05).The levels of CD3^(+)T cells,CD4^(+)T cells,CD4^(+)/CD8^(+)ratio,and NK cells were significantly higher at day 7 and at discharge than at day 1,and at discharge than at day 3 in both groups(P<0.05);there was no statistical difference between the two groups(P>0.05).The levels of IgG,IgA,IgG,C3,and C4 were significantly higher at day 7 and at discharge than at day 1,and at discharge than at day 3 in both groups;the levels of these indexes at discharge were significantly higher in the high titer group higher than in the low titer group(P<0.05).Conclusion The initial blood group antibody titer of ABO incompatible living donor kidney transplant recipients has no significant effect on the renal function and cellular immune function of the patients,but the humoral immunity level of patients with a high titer is higher after surgery.