致敏患者经双滤过法血浆分离方案预处理后行肾移植的临床效果分析

Clinical effects of double filtration plasmapheresis for sensitized recipients of cadaver kidneytransplantation

目的分析致敏患者经双滤过法血浆分离（DFPP）方案预处理，并联合使用抗CD25单抗诱导治疗后行肾移植的临床效果和安全性。方法回顾性分析2000年11至2012年1月45例致敏受者在。肾移植前经DFPP方案预处理，并联合使用抗CD25单抗诱导治疗后接受‘肾移植的临床资料。所有受者预处理前的群体反应性抗体（PRA）水平均大于20％，为（56．5±19．9）％，预处理后PRA水平降至（18．9±19．1）％。受者与供者的HLA抗原错配数为（2．1±0．7）个，术前2次供、受者淋巴细胞毒交叉配型试验均为阴性。所有受者术后至少随访1年，观察术后1年受者和移植肾存活率，以及排斥反应和肺部感染的发生情况。结果随访期间，无受者死亡，有2例受者发生移植肾功能丧失，术后1年受者存活率为100％（45／45），移植肾存活率为95．6％（43／45）。术中肾血管开放后1例发生超急性排斥反应，发生率为2．2Z，受者在切除移植肾后恢复血液透析；术后发生急性排斥反应12例，发生率为26．7％（12／45），经甲泼尼龙和（或）ATG冲击治疗后，11例完全逆转，1例出现移植肾功能丧失而恢复血液透析。术后肺部感染发生率为8．9％（4／45），经抗感染治疗后均好转，未发生重症肺部感染。结论肾移植前采用DFPP预处理，并联合使用抗CD25单抗诱导治疗安全有妁．

Objective To investigate the clinical efficacy and safety of double filtration plasmapheresis （DFPP） pretreatment combined with CD25 monoclonal antibody inducible therapy for sensitized recipients of cadaver kidney transplantatiorL Method The clinical data of 45 sensitized recipients who received the pretreatment with DFPP and CD25 monoclonal antibody from November 2011 to January 2012 were retrospectively analyzed. Panel reactive antibody （PRA） was examined by using ELISA. Before the DFPP combined with CD25 monoclonal antibody, the PRA was （56. 5±19. 9）% （〉 20%）, and after the pretreatment, the PRA level was decreased to （18. 9± 19. 1）%. HLA mismatch of recipients and donators was （2. 1 ± 0. 7）, and the lymphocytotoxic crossmatch tests before operation were negative. The incidence of patient/kidney survival, transplantation rejection and pulmonary infection were observed. All the patients were followed up for 12 months. Result During the follow-up period, no patient died, and transplanted kidney dysfunction occurred in 2/45 recipients. Twelve months after months, the survival rate was 100% and transplanted kidney survival rate was 95.6% （43/45）. One （2. 2%） of 45 recipients had hyperacute rejection during the operation, and was given plasmapheresis after the resection of the transplanted kidney. Twelve （26. 7%） of 45 recipients had acute rejection： 11 recipients completely recovered after methylprednisolone and ATG therapy, and 1 recipient given plasmapheresis for kidney dysfunction. Four （8. 9%） had the pulmonary infection after operation, and all of them recovered after antiinflammation treatment. Conclusion DFPP pretreatment before kidney transplantation combined with CD25 monoclonal antibody inducible therapy is safe and effective, specially for sensitized recipients.