同种肾移植后超急性排斥反应的发生机制及临床对策(附66例报道)

Study on pathogenesis and treatment of hyperacute rejection in 66 cases of renal grafts

目的 探讨肾移植后超急性排斥反应 (HAR)的发生机制及其临床对策。方法 回顾性分析 6 6例HAR患者。将切除的移植肾标本行形态学及荧光抗体染色观察 ;并对HAR的临床表现、治疗结果及再次手术情况等进行了总结。结果 HAR早期 ,肾间质小血管及肾小球毛细血管内大量红细胞淤滞为主要改变 ,可发现淤滞的红细胞呈串珠状贴附在血管壁上 ;本组 6 6例HAR患者中 ,2 1例于手术中立即切除移植肾 ,44例分别于术后第 1～ 2 0d切肾 ,仅 1例经对症处理后 ,移植肾逐渐萎缩未予摘除。15例HAR患者经严格配型、血浆置换及抗淋巴细胞免疫球蛋白 (ATG)治疗 ,在短期内行再次移植 ,10例获得成功。11例HAR患者 ,6个月～ 2年后再行 2次移植 ,仅 4例获得成功。结论 红细胞可能参加超急性排斥反应 ;HLAⅠ、Ⅱ类抗体高敏状态 ,是导致肾移植后HAR发生的因素 ,因此强调对高敏人群做PRA配型或随机淋巴细胞毒性试验。

Objective To study the pathogenesis and the clinical treatment of hyperacute rejection (HAR).Methods Sixty six cases of HAR were retrospectively studied. Mophological observation and fluorescence antibody staining were performed on the resected transplanted renal samples. The clinical manifestations, treatment outcome and re operative situations of HAR were summarized.Results (1) A large number of red blood cells attached onto the little blood vessels of renal interstitial and the blood capillaries of glomerulics during the early stage of HAR. As the HAR progressed, the neutrophil cells were aggregated in the capillary bed of glomerulus.(2) Twenty one renal grafts were removed during operation, while the renal grafts in 44 cases were resected 1 to 20 days after operation. Only one case of renal graft was gradually atrophy and not be removed. Twenty six cases who were defeated because of HAR received re transplantation.Conclusions Red blood cells might be involved in the HAR. The hypersensitive status of HLA Ⅰ and Ⅱ antibodies is the factor resulting in HAR following renal transplantation.