大剂量静脉滴注免疫球蛋白对免疫高敏肾移植患者的治疗研究

High dose of intravenous immunoglbulin in treatment of presensitized patients awaiting kidney transplantation patients

目的 :研究大剂量静脉滴注免疫球蛋白 ( IVIG)对高敏肾移植患者的降群体反应性抗体 ( PRA )作用及治疗效果。 方法 :通过随机多次淋巴细胞毒实验 ( RPL T) ,对 15例免疫高敏患者进行 IVIG体外抑制实验 :每例患者的血清分为实验组( IVIG)和对照组 ( PBS液 ) ,分别与随机来自血库的 2 0位健康供者的淋巴细胞进行淋巴毒实验 ,记取其阳性率。其中 5例患者接受了 IVIG,1次 /周 ,每次 0 .5 g/ kg,4周为 1个疗程 ( 4例用药 1个疗程 ,1例 2个疗程 )。 结果 :实验组淋巴细胞死亡率和RPL T阳性率均较对照组低。5例接受大剂量 IVIG的患者 ,PRA平均下降 2 3 % ( 2 %～ 5 1% )。2例 PRA降为 10 %的患者成功地接受了肾移植和胰 -肾联合移植术。结论 :IVIG可降低部分高敏患者的 PRA值 ,并使患者获得移植机会。IVIG的作用强度与其用药量大小有关 ,剂量越大作用越强。使用 IVIG治疗疗程结束后 3周左右才能达到最佳效果。

Objective: To investigate the effect of intravenous immunoglobulin in highly sensitized patients awaiting organ transplantation. Methods: IVIG was used to reduce donor specific anti HLA alloantibodies in vitro and in vivo . Fifteen patients received IVIG′s suppressive experiment in vitro by random panel lymphocytotoxicity test. The serum of patients were divided into 2 groups: one was diluted with equal volume of IVIG and the other was diluted with PBS solution, and then reacted with lymphocytes from healthy donors randomly. Of them 5 patients received the treatment by IVIG. Four patients were administrated with 0.5 g/kg. Period of treatment was 4 weeks. One patient received 8 weeks infusion in same dose, 2 patients resulted in PRA drop to 10% had received kidney and pancreas kidney transplantation. Results: The percentage of RPLT in experimental group was lower than that in control group. After large dose of infusion of IVIG, the patients showed a reduction in absolute PRA of 2% 51% (mean decrease: 23%). Two patients had undergone subsequent transplantation and no serious rejection occurred. Conclusion: Treatment with IVIG is a valuable tool for the transplantation of immunized patients. The effect of IVIG is dose dependent and can be achieved in 3 weeks.