预存供者特异性抗人类白细胞抗原抗体肾移植临床分析

Clinical analysis of kidney transplantation in patients with pre-existing donor-specific anti-human leukocyte antigen antibodies

目的分析预存供者特异性抗人类白细胞抗原抗体(DSA)肾移植的受者临床特征和移植效果。方法回顾性分析中山大学附属第一医院2011年1月至2019年10月预存DSA并经脱敏治疗行肾移植手术的16例受者资料。观察预后指标,包括受者和移植肾存活率、DSA水平变化、术后排斥反应发生情况及治疗预后。结果肾移植术后随访1~52个月,中位随访时间13个月。术后8例受者发生排斥反应,发生率50.0%。其中抗体介导的排斥反应(AMR)5例(31.3%),T细胞介导排斥反应(TCMR)2例(12.5%),亚临床排斥反应1例(6.3%)。其中1例受者术后发生排斥反应,病理确诊为AMR,术后6个月因并发重症感染导致多器官功能衰竭而死亡;1例受者术后病理确诊AMR,术后1个月发生移植肾破裂,后行移植肾切除术,术后维持血液透析治疗;其余14例受者移植肾功能恢复良好。受者1年存活率93.8%,死亡删失的移植肾1年存活率93.3%。结论肾移植术前预致敏产生DSA,经脱敏治疗后,可获得较好肾移植效果。

Objective To explore the clinical features of preoperative pre-existing donor-specific anti-human leukocyte antigen(HLA)antibody(DSA)in renal transplantation recipients.Methods Retrospective analysis was performed for 16 patients with pre-existing DSA undergoing kidney transplantation from January 2011 to October 2019.The overall prognosis of the entire cohort was observed,including patient survival,graft survival,postoperative changes of DSA level,incidence of rejection and response to anti-rejection treatment.Results After transplantation,the median follow-up period was 13(1~52)months.A total of 8 patients(50.0%)developed postoperative rejection.Five patients(31.3%)developed antibody-mediated rejection(AMR)while another two(12.5%)had an onset of T cell-mediated rejection(TCMR).There was 1 case(6.3%)of subclinical rejection.One case had postoperative rejection,pathologically confirmed as AMR,and died of multiple organ failure due to severe infection at 6 months post-operation;another case with postoperative rejection,pathologically confirmed as AMR,underwent nephrectomy plus postoperative hemodialysis due to a rupture of transplanted kidney at 1 month post-transplantation;the remainders recovered well after transplantation.The 1-year survival rate of recipients was 93.8%and the 1-year death-censored graft survival rate 93.3%.Conclusions Kidney transplantation may be performed effectively and safely in patients with pre-existing DSA after desensitization therapy.