二重血浆置换及免疫吸附联合IL-2受体单抗方案处理致敏肾移植受者的临床研究

Sensitized Kidney Transplantation Recipients Treated with Double Filtration Plasmapheresis plus Immunoadsorption Combined Interleukin-2-receptor Monoclonal Antibody:A Clinical Research

目的:评估应用二重血浆置换(DFPP)、免疫吸附(IA)联合IL-2受体单抗方案处理致敏肾移植受者的临床效果。方法:将56例致敏肾移植受者分为2组,35例试验组应用DFPP、IA联合IL-2受体单抗方案,21例对照组未进行上述处理。采用酶联免疫吸附(ELISA)方法检测肾移植受者体内群体反应性抗体(PRA)水平,比较2组急性排斥反应(AR)和肾功能延迟恢复(DGF)的发生率,随访2组人/肾1a存活率及术后6个月和12个月的血肌酐情况。结果:试验组PRA明显下降,PRA降为阴性者14例;试验组与对照组术后AR发生率分别为28.6%、42.9%(P<0.05),DGF发生率分别为8.6%、14.3%(P>0.05),1a人存活率分别为100.0%、95.2%(P>0.05),移植肾1a存活率分别为94.3%、76.2%(P<0.05),随访6个月/12个月血肌酐分别为(115.2±16.6)/(121.2±28.6)μmol.L-1和(128.4±27.4)/(134.6±33.7)μmol.L-1(P<0.05)。结论:DFPP、IA联合IL-2受体单抗方案可选择性去除受者体内的致敏抗体,可降低致敏受者术后AR的发生率,提高术后肾移植受者1a移植肾存活率,术后6个月和12个月的血肌酐水平也较低。

OBJECTIVE： To evaluate the clinical efficacy of double filtration plasmapheresis （DFPP） plus immune adsorption （IA） combined interleukin - 2 - receptor monoclonal antibody in the treatment of sensitized kidney transplantation recipients. METHODS： A total of 56 sensitized kidney transplantation recipients were enrolled： 35 cases （trial group） were treated with DEPP plus IA combined interleukin- 2- receptor monoclonal antibody, and another 21 cases（control group） were not given the above - mentioned treatment. Panel reactive antibody （PRA） in the sensitized kidney transplantation recipients was examined with ELISA. The incidences of acute rejection （AR） and delayed graft function （DGF） were compared between the two groups, and the patient/ kidney 1 year survival rates and serum creatinine at 6 and 12 months were followed. RESULTS： In the trial group, PRA decreased significantly, with PRA in 14 cases turned to negative. In trial group vs. control group, the incidence of AR was 28.6% vs. 42.9% （P〈0.05）, DGF incidence was 8.6% vs. 14.3% （P〉 0.05）; the 1 year survival rate of patients was 100.0% vs. 95.2% （P 〉 0.05）; and the 1 year survival rate of grafted kidneys was 94.3 % vs. 76.2%（P〈0.05）. The creatinine values at 6 and 12 month were（115.2± 16.6）/（128.4±27.4）μmol·L^-1 for the trial group vs.（121.2±28.6）/（134.6±33.7）μmol·L^-1 for the control group（P〈0.05） . CONCLUSION： DFPP plus IA combined interleukin - 2- receptor monoclonal antibody can eliminate the sensitive antibody selectively, reduce the incidence of AR after kidney transplantation, improve the 1 year graft survival rate, and down - regulate the serum creatinine levels at 6 months and 12 months for kidney transplantation recipients.