小肠移植患者ABO血型不合抗体效价监测(附1例报告)

One case of blood type antibody titer determination of ABO incompatiblility aplastic small intestine transplantation

目的观察ABO血型不合小肠移植前后的变化,随时采取治疗措施降低抗体效价。方法术前2周开始对受者进行IgM、IgG抗-B效价检测,移植前d9开始进行血浆置换,隔天1次,共置换4次,每次置换前后对抗体效价进行检测。结果经4次血浆置换后,术前IgM抗-B效价由128降至1,IgG抗-B效价由16降至0,术后配合免疫抑制剂治疗,IgM抗-B效价持续≤2,IgG抗-B效价均为0,未发生抗体介导的急性排斥反应。结论血型不合的小肠移植,手术前后监测抗体效价,特别是手术前抗体效价尽可能地降至1,对降低移植术后超急性血管性排斥反应,控制免疫抑制剂的用量有很重要的意义。

Objective To investigate the antibody titer changes after the ABO incompatiblility aplastie small intestine transplantation and to take measures to lower the antibody titer at any time. Methods Detecting IgM and IgG anti-B titer of the recipient two weeks before the transplantation. Plasmapheresis was performed 9th days before the transplantation and 4 times in all interval one day. In addition, detecting the antibody titer before and after the plasmapheresis is necessary. Results After 4 times of plasmapheresis,preoperative IgM anti-B titer decreased from 128 to 1 and IgG anti-B titer from 16 to 0. Based on immunosuppressive therapy .after surgery, IgM anti-B titer is less than 2 and IgG anti-B titer is O eontinuouslly. Antibody-mediated acute reject reaction don＇t happen. Conclusion It＇s necessary to monitor the antibody ti-ter before and ＇after small intestine transplant of ABO incompatible, and then to lower antibody titers to 1 as possible before surgery. There is very important to reduce postoperative hyperaeute allograft vascular rejection reaction and control the usage of immunosuppressor.