高PRA肾移植受者术前血液透析滤过联合血浆置换效果

HEMODIAFILTRATION COMBINED WITH PLASMA EXCHANGE FOR RENAL TRANSPLANT RECIPIENTS WITH HIGHLY SENSITIVE TO PANEL REACTIVE ANTIBODY

目的探讨血液透析滤过(HDF)联合血浆置换(PE)用于群体反应性抗体(PRA)高敏肾移植受者术前治疗的可行性、安全性、有效性。方法 9例高PRA肾移植受者术前应用HDF联合PE治疗,治疗平均持续时间3.5～4.0h,治疗2次。于治疗前后检测病人PRA、血肌酐(Cr)、尿素氮(BUN)、血浆清蛋白(ALB)、血钾、血钠、血糖的变化。结果 HDF联合PE治疗后PRA值较治疗前下降(t=4.14,P<0.01),治疗后PRA值3例转阴,5例<10%,1例<30%。术后超急性排斥反应发生率为0,发生急性排斥反应1例,经治疗后逆转。治疗后Cr、BUN、血钾、血糖均较治疗前下降,ALB较治疗前升高,差异有显著性(t=2.60～10.94,P<0.05、0.01)。结论HDF联合PE治疗高PRA肾移植受者安全、有效。

Objective To discuss the feasibility,safety and effectiveness of combined hemodiafiltration（HDF） and plasma exchange（PE） as a preoperative therapy for renal transplantation in patients highly sensitive to panel reactive antibody（PRA）.Methods Combined HDF and PE therapy was applied in nine patients with high level of PRA before renal transplantation,3.5-4.0 hours for each treatment of two treatments.Blood PRA,Cr,BUN,ALB,K＋,Na＋ and glucose were measured before and after treatment.Results After combination therapy,the serum PRA level decreased significantly： three cases returned to normal;five decreased to 10%;one decreased to 30%;the incidence of postoperative hyperacute rejection was 0,one with acute rejection was relieved after treatment.Blood Cr,BUN,K＋,Na＋ and glucose decreased,and ALB increased,as compared with before treatment,the differences being significant（t=2.60-10.94;P0.05,0.01）.Conclusion Combination of HDF and PE is safe and effective as a preoperative therapy before renal transplantation in patients highly sensitive to PRA.