血浆置换预防和治疗肾移植后加速及超急性排斥反应的观察

Plasma exchange preventing and treating acute accelerated and hyperacute rejection after renal transplantation

目的 探讨血浆置换疗法 (PE)对预防和治疗肾移植后排斥反应的疗效。方法 选择 30例肾移植前群体反应抗体 (PRA)增高≥ 30 %及 10例肾移植后出现加速性排斥反应的患者 ,在用免疫抑制剂的同时作膜分离法血浆置换。结果 PE能清除各种免疫球蛋白及循环抗体 ,PE前后对比差异有显著性 (P <0 .0 1) ,PE治疗后全部患者 ( 30例 )PRA≤ 10 % ,肾移植后经过 6～ 9个月的观察 ,2 7例 (占90 % )未出现超急、加速或严重的急性排斥反应 ;10例肾移植后出现加速性排斥反应者 ,8例 (占 80 % )逆转。结论 PE配合免疫抑制剂治疗 。

Objective To explore the therapeutic effects of plasma exchange (PE) for rejections after renal transplantation. Methods PE was carried out on 30 patients whose population reactive antibodies (PRA) level was more than 30?% and 10 patients who suffered from acute accelerated rejections after transplantation at the same time of administration of immunosupressants. Each of these patients accepted PE one time every two days, 3 000 ?ml each time, totally 2～4 times. Different indexes including immunoglobulins, complements and clinical manifestations were monitored before and after PE. Results PE could cleared various immunoglobulins and circulatory antibodies with the difference being significant ( P < 0.01 ). After PE, the high PRA was decreased to less than 10?% in all patients and 8 of the 10 patients with acute accelerated rejections reversed. During the follow up of 6 to 9 months, 27 of the 30 cases with high PRA suffered neither hyperacute nor acute-accelerated, nor acute rejections. Conclusion PE in combination with immunosupressants had a definitive therapeutic effect in the acute rejections following renal transplantation.