血浆置换联合利妥昔单抗治疗肾移植术后抗体介导的排斥反应1例报告并文献复习

Plasmapheresis combination with rituximab in treatment of antibody mediated rejection after renal transplantation: a case report and literature review

目的探讨血浆置换联合利妥昔单抗治疗肾移植术后抗体介导排斥反应(antibodymediated rejection,AMR)的疗效。方法回顾分析1例发生AMR的肾移植受者的临床资料并复习相关文献。结果 1例女性患者,肾移植术后7年,分娩后移植肾失功,1年后行二次肾移植术。术后予他克莫司(FK506)+麦考酚吗乙酯(MMF)+泼尼松三联免疫抑制治疗,肾功能正常。术后5 d患者出现突发尿少,移植肾区胀痛,群体反应性抗体(PRA)Ⅰ类分子升高至14.29%,供体特异性抗体(donor-specific antibody,DSA)阳性,血清肌酐(Scr)升高达606μmol/L,予血浆置换1次(血浆2 000 ml),置换后给予单剂利妥昔单抗500 mg静脉滴注,治疗18 d后复查PRA及DSA阴性,尿量增加,肾功能恢复正常。患者随访至2011年6月,查PRA及DSA一直维持阴性,肾功能良好。结论血浆置换联合利妥昔单抗用于治疗肾移植术后AMR有一定疗效。

Objective To investigate the efficacy of plasmapheresis combination with rituximab in treatment of antibody mediated rejection（AMR）after renal transplantation.Methods Clinical data of a female recipient with AMR was retrospectively analyzed and the related literatures were reviewed.Results A female recipient,who received her first renal transplantation seven years ago,developed renal failure after parturition.She received renal re-transplantation one year later and underwent triple immunosuppression treatment including tacrolimus（FK506）＋mycophenolate mofetil（MMF）＋ prednisone（Pred）post-transplantation with normal renal function.The recipient developed oliguria and pain of the kidney all of a sudden on day 5 after re-transplantation.The panel reactive antibody（PRA） Ⅰ of this recipient increased to 14.29% with positive donor-specific antibody（DSA）.The serum creatinine（Scr） was 606 μmol/L and a single plasma pheresis（2 000 ml） was performed.After that,a single dose of rituximab（500 mg） was administrated to this recipient.Eighteen days after this treatment,PRA and DSA of this recipient were all negative with good kidney function during the follow-up until June 2011.Conclusions Plasmapheresis combined with rituximab shows efficacy in treating AMR after renal transplantation.