蛋白A免疫吸附清除致敏肾移植受者HLA抗体的临床观察

Clinical Observation of the Clearance of HLA Antibodies in Sensitized Renal Transplant Recipients by Protein A Immunoadsorption

目的探讨蛋白A免疫吸附治疗对术前群体反应性抗体(PRA)阳性的肾移植受者HLA抗体的清除效果及安全性。方法选取2017年5月-2018年10月昆明市第一人民医院收治的拟行肾移植术致敏肾移植受者7例为研究对象,治疗方案中均接受蛋白A免疫吸附联合小剂量免疫抑制剂治疗。比较治疗前后免疫球蛋白(IgG、IgA、IgM)、补体(C_(3)、C_(4))、PRA及HLA抗体MFI值。结果7例受者共接受27例次蛋白A免疫吸附治疗均未出现不良反应。治疗后IgG、IgA、IgM、C_(3)、C_(4)低于治疗前,差异有统计学意义(P<0.05);治疗后、随访1个月PRA-Ⅰ类抗体低于治疗前,且随访1个月PRA-Ⅰ类抗体低于治疗后,差异有统计学意义(P<0.05),而治疗前后及随访1个月PRA-Ⅱ类抗体比较,差异无统计学意义(P>0.05);3例患者治疗前后HLA-Ⅰ类抗体MFI值比较,差异有统计学意义(P<0.05),2例治疗前后HLA-Ⅱ类抗体MFI值比较,差异有统计学意义(P<0.05);其余4例患者治疗前后HLA-Ⅰ、HLA-Ⅱ类抗体MFI值比较,差异无统计学意义(P>0.05)。结论蛋白A免疫吸附可以安全有效降低PRA水平和HLA抗体水平。经联合小剂量免疫抑制剂治疗,可使下降的HLA抗体维持至少2周不反弹,为致敏移植患者提供一个相对安全的“窗口期”。

Objective To investigate the effect and safety of protein A immunoadsorption therapy on the clearance of HLA antibodies in renal transplant recipients with positive preoperative panel reactive antibody(PRA).Methods A total of 7 sensitized renal transplant recipients who were admitted to the First People's Hospital of Kunming from May 2017 to October 2018 were selected as the study subjects.All patients received protein A immunoadsorption combined with low-dose immunosuppressive therapy.The MFI values of immunoglobulin(IgG,IgA,IgM),complement(C_(3),C_(4)),PRA and HLA antibody were compared before and after treatment.Results A total of 27 protein A immunoadsorption treatments were performed in 7 recipients without adverse reactions.After treatment,IgG,IgA,IgM,C_(3) and C_(4) were lower than those before treatment,and the difference was statistically significant(P<0.05).The PRA-Ⅰantibody after treatment and 1 month of follow-up was lower than that before treatment,and the PRA-Ⅰantibody after 1 month of follow-up was lower than that after treatment,the differences were statistically significant(P<0.05).There was no significant difference in PRA-Ⅱantibody before and after treatment and 1 month of follow-up(P>0.05).The MFI values of HLA-Ⅰantibody in 3 patients before and after treatment were significantly different(P<0.05),and the MFI values of HLA-Ⅱantibody in 2 patients before and after treatment were significantly different(P<0.05).There was no significant difference in the MFI values of HLA-Ⅰand HLA-Ⅱantibodies before and after treatment in the other 4 patients(P>0.05).Conclusion Protein A immunoadsorption can safely and effectively reduce PRA level and HLA antibody level.Combined with low-dose immunosuppressive therapy,the decreased HLA antibody can be maintained for at least 2 weeks without rebound,providing a relatively safe"window period"for sensitized transplant patients.