淋巴细胞去除加血浆置换对高敏患者肾移植后排斥反应的影响

Influence of lymphopheresis and plasma exchange therapy on renal transplant rejection in highly sensitive

目的 探讨淋巴细胞去除＋血浆置换（PE）减少高敏患者肾移植后排斥反应的疗效。方法32例肾移植前群体反应性抗体（PRA）阳性≥30％（30％～90％）患者，先作血淋巴细胞去除加PE治疗（LAPE）1～3次后，当PRA〈30％后才作尸体肾移植作治疗组。32例PRA阳性，强度≥30％（30％～70％）患者进行尸体肾移植作对照组。比较两组患者术后6个月内排斥反应情况。结果对照组术后排斥反应率为68．8％（22／32）。治疗组移植后排斥反应发生率为9．4％（3／32），P〈0．001。结论淋巴细胞去除加PE治疗能明显减少有预先形成抗体的高敏患者的肾移植后排斥反应，疗效满意。

Objective To investigate the effect of lymphopheresis and plasma exchange（PE） therapy on reducing renal transplantation rejection in highly sensitive recipients. Methods Rejections within 6 months after renal transplantation were compared between the groups of patients. One of which was composed of 32 recipients whose panel reactive antibody levels before the transplantation were from 30% to 70% , and another was composed of 32 recipients whose panel reactive antibody levels were from 30% to 90% . The later group of patients received lymphopheresis and PE therapy before transplantation and had not undergone renal transplantation operation until their panel reactive antibody levels were below 30% or negative. Resuits After transplantation, the rejection incidence was 68. 8% （22/32） for those 32 recipients without lymphopheresis and plasma exchange therapy and 9. 4% （3/32） for the 32 recipients receiving lymphopheresis and PE therapy respectively. The difference was very sign（ficant P 〈 0. 001. Conclusion For the highly sensitive recipients who have the Pre - transplant antibodies, lymphopheresis and PE therapy can significantly reduce the post transplant rejection incidence.