双重血浆滤过与血浆置换在ABO血型不相容肾移植术前预处理中的对比研究

Comparative study of dual plasma filtration plasmapheresis and plasma exchange in the preconditioning of ABO incompatible renal transplantation

目的对比研究双重血浆滤过(DFPP)与血浆置换(PE)两种血型抗体清除方法在ABO血型不相容(ABOi)肾移植术前预处理中的血型抗体清除效率、并发症及对血细胞计数、凝血功能和手术安全性的影响。方法回顾性分析安徽省立医院2020年1月至2020年6月单纯采用DFPP预处理的9例ABOi肾移植受者和单纯采用PE预处理的10例ABOi肾移植受者的临床资料,收集并分析两组受者各阶段的血型抗体滴度、血细胞计数和凝血功能等参数。结果DFPP组和PE组分别共行23、24次血浆处理,均未发生严重并发症;PE处理过程中发生不良反应发生率41.67%显著高于DFPP组4.35%(P=0.003);DFPP组和PE组受者经预处理后血型抗体IgM、IgG滴度均达到≤1∶8的合格标准,IgM的清除效率分别为1.29±0.46、1.31±0.46(P=0.955),IgG的清除效率分别为0.84±0.16、1.13±0.50(P=0.288);DFPP组完成整个血浆处理过程后,凝血酶原时间延长、国际标准化率升高、纤维蛋白原(FIB)降低、凝血酶时间延长,对比血浆处理前差异均有统计学意义,至手术当日除FIB外,其他指标均恢复至正常范围;PE组完成整个血浆处理过程后,FIB降低、红细胞计数降低,对比血浆处理前差异均有统计学意义;两组受者均接受ABOi肾移植,手术均顺利,术前、术后血红蛋白水平差异无统计学意义,住院期间均未发生出血、感染、急性排斥反应等严重并发症,出院时平均血清肌酐值差异无统计学意义。结论DFPP和PE在ABOi肾移植预处理过程中均安全有效,DFPP摆脱血浆供给依赖的同时明显降低了血浆处理过程中的并发症,通过加强凝血功能监测能够保证肾移植手术安全。

Objective To compare the difference of ABO blood group antibody cleaning efficiency,complications,blood cell counts,coagulation function and surgical safety between double plasma filtration(DFPP)and plasma exchange(PE)in the preconditioning of ABO-incompatible kidney transplantation(ABOi-KT).Methods Nine ABOTi-KT recipients pretreated with DFPP and 10 ABOi-KT recipients pretreated with PE were retrospectively analyzed.And the relevant parameters of ABO blood antibody titers,blood cell counts,coagulation function and serum creatinine were collected for statistical analysis.Results Recipients received 23 and 24 sessions of plasma treatment in DFPP and PE groups respectively.The incidence of adverse reactions during PE treatment was significantly higher than that of DFPP group(41.67%vs 4.35%,P=0.003).No serious complications occurred.After pretreatment,blood type IgM and IgG titer of DFPP and PE groups declined to below or equal to 1:8.The clearance efficiency of IgM was 1.29±0.46 and 1.31±0.46(P=0.955)and the clearance efficiency of IgG 0.84±0.16 and 1.13±0.50 respectively(P=0.288).Coagulation function was affected significantly by DFPP.Except for FIB level,most parameters normalized on the day of operation.FIB and erythrocyte count decreased after plasma treatment in PE group.All recipients of two groups underwent living kidney transplantation successfully.And no significant difference existed in hemoglobin level before and after transplantation.No such serious complications as hemorrhage,infection or acute rejection occurred during hospitalization.No statistical difference existed in serum creatinine levels at discharge.Conclusions DFPP and PE are both safe and effective for ABOi-KT preconditioning.DFPP is plasma supply-independent and it significantly reduces complications during plasma treatment.Enhancing the coagulation function monitoring of ABOi-KT patient ensures the safety of kidney allograft.