高度致敏肾移植患者的围术期处理

The clinical experience in 22 cases of renal transplantation in highly sensitized recipients

目的探讨高度致敏肾移植患者的围手术期处理。方法对22例高度致敏肾移植患者术前组织配型及预处理，术后抗排异方案以及肾功恢复情况进行研究。结果17例患者术前经血浆置换3～8次后群体反应性抗体（PRA）降至30％以下，5例患者术前PRA仍大于50％。术后发生超急性排斥反应（HAR）1例（9．9％），抗排异反应未能逆转，予以切除移植肾；急性排斥反应（AR）8例（36．3％），经甲强龙＋ATG（ALG）冲击治疗后6例肾功恢复正常，2例转为肾功能延迟恢复（DGF）；术后DGF5例（22．7％），予以血液透析＋低剂量抗排异药物维持，肾功均恢复正常。结论避开相应抗体进行良好的组织配型，是高度致敏患者肾移植成功的关键；术前行血浆置换降低高度致敏患者PRA，使用ATG或ALG可降低手术风险，提高排斥反应逆转率。

Objective To approach the perioperative treatment of renal allografts in highly sensitized recipients. Methods The panel reactive antibody （PRA）, human leukocyte antigen （HLA） matching and renal transplantation results of 22 highly sensitized recipients were retrospectively analyzed. Re- sults Among highly sensitized recipients, 17 eases had PRA 〈 30% through the plasmapheresis, and the remaing 5 cases 〉 50%. There was 1 case of hyperacute rejection, and the renal graft was cut. In 8 cases of acute rejection,6 cases were subjected to the therapy of MP ＋ ATG （ALG） and the renal function was nor- real, a^d 2 cases had DGF. The renal function of 5 cases of DGF was normal after the hematodialysis and medication. Conclusion To avoid specific antibody through HLA matching is the key point for successful renal transplantation of highly sensitized recipients. The preoperative plasmapheresis can reduce the PRA, which results in relatively deteriorated allograft function and lower allograft survival rate. Excellent tissue matching and use of ATG or ALG may help in reduction of AR episodes and improvement of graft function.