双滤过血浆分离清除高敏肾移植受者体内群体反应性抗体的临床疗效观察

Clinical research of elimination of panel reactive antibodies with double filtration plasmapheresis in highly sensitive kidney recipients

目的观察双滤过血浆分离（DFPP）清除高敏肾移植受者体内群体反应性抗体（PRA）的疗效。方法使用Plasauto iQ全自动血液净化仪和EC-20W血浆成分分离器对26例高敏肾移植受者进行双膜滤过治疗，每周2次，共治疗4周，检测治疗前后患者的PRA水平，同时观察患者体内免疫球蛋白和白蛋白变化情况。结果9例患者PRA转阴（〈10％），15例患者PRA降至可接受肾移植范围（〈40％），2例患者PRA水平仍高于40％。DFPP治疗前PRA水平为（61．3±15．2）％，治疗后下降至（22．2±12．7）％，差异有统计学意义（P〈0．05）；治疗后IgG、IgM均显著下降（P均〈0．05），而IgA、白蛋白水平改变不明显。结论DFPP能够有效清除高敏肾移植受者体内的PRA，同时保留自身蛋白质。

Objective To evaluate the therapeutic effect of elimination of panel reactive antibodies （PRA） with double filtration plasmapheresis （DFPP） in highly sensitive kidney recipients. Methods DFPP was carried out in 26 highly sensitive kidney recipients （PRA〉40%）. DFPP was conducted by the application of a double-filtration technique with a membrane plasmapheresis apparatus （total automatic Plasauto iQ）. EC-20W was used as a plasma fractionator and separator. DFPP was performed twice a week and four weeks later. The PRA levels were detected with Lambda Antigen Tray before and after DFPP. In the meantime the changes in immunoglobulins and albumin in the patients were investigated. Results Approximately 70% of serum IgM and 60 % of IgG were removed by DFPP treatment. PRA level was decreased from （61.3± 15.2）% to （22. 2±12. 7）% （P〈0. 05）. In 9 patients, PRA turned negative （PRA〈10%）. In 15 patients, their PRA levels were sufficiently low （PRAY40 %） in the range allowable for undergoing kidney transplantation. In other 2 patients, the PRA level was still more than 40%. The changes in IgA and albumin levels were not significant. Conclusion The PRA of highly sensitive kidney recipients can be efficiently eliminated by DFPP, and in the meantime, it may preserve protein such as albumin in them. Thus, DFPP gives the highly sensitive patients the chance of kidney transplantation.