高致敏受者再次肾移植3例报告并文献复习

Kidney retransplantation for highly-sensitized patients

目的探讨对高致敏受者再次进行肾移植的方法。方法 3例高致敏受者再次肾移植术前选择合适的供者,包括亲属活体供肾,供受者间HLA配型良好,淋巴细胞毒交叉配型试验结果均为1%,供者特异性抗体检测阴性。免疫抑制方案采用他克莫司+吗替麦考酚酯+泼尼松三联方案并分别联合利妥昔单抗、抗胸腺细胞球蛋白、巴利昔单抗治疗。脱敏方案采用血浆置换或免疫吸附或血浆置换+低剂量静脉用免疫球蛋白。结果 3例手术均成功,受者无排斥反应发生,术后1～3 d血清肌酐降至正常。3例受者随访29～42个月人肾均存活,术后未发生病毒感染及肺炎,无肝功能损害发生。结论良好的HLA配型和避免供者特异性抗体是高致敏患者再次肾移植成功的关键。采用巴利昔单抗、抗胸腺细胞球蛋白、利妥昔单抗及脱敏治疗可以减少排斥反应的发生。

Objective To evaluate the safety and efficacy of kidney retransplantation in highly-sensitized patients.Methods A total of 3 highly-sensitized patients received living donor kidney retransplantation.HLA was matched very well and complement dependent cytotoxity test was 1%.The donor-specific anti-HLA antibodies were negative.The protocol of anti-rejection therapy comprised tacrolimus,mycophenolate mofetil,and steroid,as well as basiliximab,anti-thymocyte globulin,or rituximab.Desensitization was carried out with plasmapheresis or immunoadsorption,or plasmapheresis combined with intravenous immunoglobulin.Results All the retransplants were successful with renal function back to normal in 1 to 3 days after surgeries.No hyperacute rejection and acute rejection occurred,and no infection and impaired liver function was noted.Conclusion In highly-sensitized patients with retransplantation,a good matching of HLA and avoidance of specific antibodies before operation are important factors for success.Therapy with basiliximab,anti-thymocyte globulin,plasmapheresis,intravenous immunoglobulin,and rituximab may effectively reduce the incidence of rejection.