胰肾联合移植术后排斥反应分析

Analysis of rejection after simultaneous pancreas-kidney transplantation

目的 探讨预防和逆转胰肾联合移植术后排斥反应的方法。方法 回顾性分析 1999年 9月～ 2 0 0 3年 9月 17例同种异体胰肾联合移植手术患者的临床资料。全部病例采用口服免疫抑制剂 :环孢素A、霉酚酸酯或硫唑嘌呤、激素三联用药。其中 2例术前及术后第 5天应用抗IL 2R单克隆抗体 ,3例应用OKT3进行免疫诱导。结果 17例患者中 1例发生移植胰腺、肾脏加速性排斥反应 ,经保守治疗无效 ,切除移植物 ;8例发生急性排斥反应 ,其中单纯肾脏排斥反应 6例 ,同时累及胰腺、肾脏的排斥反应 2例 ,经甲泼尼龙或OKT3治疗后均逆转。结论 胰肾联合移植术后合理应用免疫抑制剂 ,术前采用综合措施降低高危受者的致敏性 。

Objective To explore methods of preventing and reversing rejection after simultaneous pancreas kidney transplantation (SPK). Methods Seventeen patients performed SPK operation from Sep,1999 to Sep,2003 were reviewed retrospectively. Immunosuppression was achieved by triple regimen consisting of cyclosporine, mycophenolate mofteil (MMF)/azathioprine and steroid. 2 patients were treated with Dalizumab,the other three patients used OKT3 as immune inductioin. Results 1 patient experienced the accelerated rejection, the pancreas and kidney grafts were resected because of failure of conservative therapy. 8 patients experienced renal acute rejection, 2 cases suffered from pancreas acute rejection at the same time. All these patients received daily high dose pulse steroid for 3 days. OKT3 was administered in 2 patients with steroid resistance rejection. All the grafts were successfully rescued. Conclusions Reasonable application of immunosuppression after SPK operation and adoption of systemic measures which can reduce sensitivity of high risk receptor before SPK operation are the effective methods of preventing and treating rejection.