3种不同的围手术期处理方法应用于肾移植致敏受者的疗效比较

Effective comparison of three different peri-operative managements for sensitized recipients of renal transplantation

目的:比较肾移植致敏受者围手术期分别采用血浆置换、免疫吸附或静脉用免疫球蛋白(intravenous immunoglobulin,IVIG)治疗对降低群体反应抗体(panel reactive antibody,PRA)和减少肾移植术后排斥反应的效果。方法:122例肾移植致敏受者分为3组,分别在术前使用血浆置换(69例)、免疫吸附(33例)、IVIG(20例)治疗,并于治疗前后及肾移植术后监测PRA的变化和排斥反应情况。结果:治疗后血浆置换组、免疫吸附组、IVIG组的PRA水平比治疗前分别下降45％、45％、55％;肾移植术后1年,3组PRA的反弹率分别为41％、420k、30％;且IVIG组比其它两组发生急性排斥反应病例要少、结论:肾移植致敏受者围手术期采用血浆置换、免疫吸附或IVIG等方法治疗均可降低PRA水平, 减少急性排斥反应的发生率,其中IVIG组效果更佳。部分患者术后PRA会反弹,使用免疫抑制药可使 PRA稳定在较低水平。

Objective： To investigate the effect of peri-operative management using plasma exchange, immunoadsorption or intravenous immunoglobulin （IVIG） to manage PRA and post operative rejection in sensitized recipients after renal transplantation. Methods： 122 recipients whose PRA were bigger than 10 percent were treated with plasma exchange （69 cases）, immunoabsorption （33 cases） and IVIG （20 cases） respectively before operation. At the same time the change of PRA and the events of rejection were monitored. Results： After treat with plasma exchange, immunoabsorption or IVIG management, the PRA level decreased 45%, 45% , 55% respectively. The rebound rate were 41% , 42% , 30% respectively one year after kidney transplantation. The acute rejection cases were fewer in IVIG group than the other two groups. Conclusion： Peri-operative management using plasma exchange, immunoabsorption or IVIG can decrease PRA and the incidence of rejection in sensitized recipients. IVIG group can achieve better results than others. The PRA can rise again in some recipients, but can be kapt in relatively lower level by using immunosuppressive drugs.