淋巴血浆置换术在ABO血型不相容亲属活体肾移植中的应用

Lymphoplasmapheresis in ABO-incompatible Living Donor Kidney Transplantation

目的探讨淋巴血浆置换术(Lymphoplasmapheresis,LPE)对ABO血型不相容亲属活体肾移植(ABOincompatible kidney transplantation,ABOi-KT)患者的疗效。方法8例ABOi-KT患者手术前共接受LPE治疗57次,比较LPE治疗前后血细胞计数、血浆蛋白含量差异;监测患者围手术期血型抗体效价变化;分析不良反应发生情况。结果患者LPE治疗前后比较,白细胞计数、中性粒细胞计数、血红蛋白、红细胞计数无明显变化(P>0.05),治疗后淋巴细胞计数和血小板计数较治疗前明显下降,差异有统计学意义(P<0.05);LPE治疗前后血浆总蛋白、白蛋白相比较无明显变化(P>0.05),治疗后球蛋白较治疗前含量明显下降,差异有统计学意义(P<0.05);每例患者经数次LPE治疗,保证ABOi-KT手术当天血型抗体效价≤1∶16,且术后2周效价无反弹;LPE治疗中不良反应发生率为8.8%。结论ABOi-KT患者术前应用LPE治疗,有助于手术更安全、有效的实施。

Objective To investigate the effect of Lymphoplasmapheresis(LPE)on patients of ABO-incompatible living donor kidney transplantation(ABOi-KT).Methods Eight ABOi-KT patients received LPE treatment 57 times before surgery.Blood cell count and plasma protein content were compared before and after LPE treatment.Perioperative blood group antibody titers were monitored.The occurrence of adverse reactions was analyzed.Results There were no significant differences in white blood cell count,neutrophil count,hemoglobin and red blood cell count between before and after LPE treatment(P>0.05).Lymphocyte count and platelet count decreased after treatment(P<0.05).There were no significant changes in plasma total protein and albumin between before and after treatment(P<0.05).The amount of globulin decreased after treatment(P<0.05).Each patient received several LPE treatments to ensure that the blood group antibody titers on the day of ABOi-KT surgery was less than 1∶16,and there was no titer rebound in two weeks after surgery.The incidence of adverse reactions in patients received LPE treatment was 8.8%.Conclusion Preoperative LPE treatment for ABOi-KT patients is helpful for safe and effective operation.