术前治疗性血浆置换预防ABO血型不合肾移植术后急性排斥反应的回顾性分析

Preoperative therapeutic plasma exchange to prevent acute rejection after ABO incompatible renal transplantation:a retrospective analysis

目的 探讨术前治疗性血浆置换(therapeutic plasma exchange,TPE)预防ABO血型不合肾移植(ABO incompatible kidney transplantation,ABOi-KT)术后急性排斥反应的临床疗效。方法 我们搜集了2022年4月至2024年4月在本院肾移植科室住院的9名ABO血型不合肾移植患者进行回顾性分析,9名患者在肾移植手术前共进行了28次TPE,总结治疗方案:根据入院时患者的ABO血型系统抗体效价水平、性别、身高、体重、红细胞压积等指标制定置换液的比例、置换次数和置换量。同时监测患者入院时及TPE后相关实验室指标,如:血红蛋白、血小板、白细胞、凝血功能、总蛋白、白蛋白、球蛋白、白球比、肌酐、尿素氮,并对其进行统计学分析。在移植术后检测ABO血型系统抗体效价变化,肌酐和尿量变化等肾功能指标,观察有无急性排斥反应的临床症状,如:移植肾区肿胀、疼痛、水肿等表现。结果 9名ABOi-KT患者术前平均血浆置换次数约为3次,平均每次置换液总量约为2 500~3 500 mL,大约为1.01~1.16血浆容量(plasma volume,PV),数次TPE后在移植术前抗体效价水平较前可平均下降3倍。Hb、PLT、PT、PTA、INR、TBil、ALB、Cr、BUN无统计学差异(P>0.05),WBC、APTT、Fbg、TP、GLB、A/G具有统计学意义(P<0.05)。术后9名患者肌酐可降至100~140μmol/L左右,尿量正常,尿蛋白下降至弱阳性或阴性,9名患者均未发生急性排斥反应。结论 TPE可有效降低ABO系统血型抗体水平,可有效预防ABO血型不合患者肾移植急性排斥反应的发生。

Objective To investigate the clinical efficacy of preoperative therapeutic plasma exchange(TPE) in preventing acute rejection after ABO incompatible kidney transplantation(ABOi-KT).Methods Nine patients with ABOi-KT who were admitted to the renal transplant department of our hospital from April 2022 to April 2024 were retrospectively analyzed.They received a total of 28 TPEs before kidney transplantation,and the treatment plan was summarized as follows:The proportion of the substitute fluid,as well as the frequency and volume of TPE were determined based on the patient′s ABO blood group system antibody titer,gender,height,weight,hematocrit and other indicators upon admission.The patient′s relevant laboratory indicators,including hemoglobin,platelets,leukocytes,coagulation function,total protein,albumin,globulin,A/G,creatinine and urea nitrogen upon admission and after TPE were monitored and statistically analyzed.After transplantation,changes in renal function indicators such as ABO blood group system antibody titers,creatinine and urinary excretion were observed,and clinical symptoms of acute rejection,such as swelling,pain and edema in the transplanted kidney area were observed.Results Nine ABOi-KT patients had an average of about 3 TPEs before transplantation surgery,with an average total volume of approximately 2 500 mL to 3 500 mL per TPE,or approximately about 1.01 to 1.16 plasma volume(PV).After multiple TPEs,pre-transplantation antibody titers decreased by an average of 3 times compared to before TPE.There were no statistically significant differences in Hb,PLT,PT,PTA,INR,TBil,ALB,Cr and BUN(P>0.05),while statistically significant differences were found in WBC,APTT,Fbg,TP,GLB and A/G(P<0.05).After surgery,the creatinine level of 9 patients dropped to approximately 100 to 140 μmol/L,the urine output was normal,and the urine protein dropped to weakly positive or negative values.None of the nine patients experienced acute rejection.Conclusion TPE can effectively reduce the level of ABO blood group antibody and prevent the occurrence of acute rejection in ABOi-KT patients.