免疫吸附在高致敏肾移植受者围手术期应用的单中心经验总结

Perioperative application of immunoadsorption in highly sensitized kidney transplant recipients:single-center experience

目的探讨免疫吸附在高致敏肾移植受者的应用价值。方法回顾性分析2019年9月至2023年4月于树兰(杭州)医院接受蛋白A免疫吸附去致敏治疗后行肾移植的26例高致敏肾移植受者的相关数据及临床资料,总结免疫吸附降低高致敏肾移植受者抗人类白细胞抗原(human leucocyte antigen,HLA)抗体的效果及去致敏治疗后手术的成功率及术后并发症的发生率。结果26例高致敏肾移植受者在术前接受免疫吸附去致敏治疗(10.76±5.53)次,受者HLA-Ⅰ类抗体最高水平平均荧光强度(mean fluorescence intensity,MFI)从17921±4442降低至7333±6434,下降率为59%;HLA-Ⅱ类抗体最高水平MFI从21135±5245降低至10989±7627,下降率为48%,治疗前后差异均有统计学意义(P值均<0.001)。治疗后26例受者均行遗体捐献肾移植手术,7例受者术后早期发生急性抗体介导的排斥反应,3例受者围手术期发生肺部感染,2例受者发生骨髓抑制;随访时间为(30.8±12.6)个月,移植肾存活率为88.5%(23/26),受者存活率为100%(26/26)。结论免疫吸附能有效降低高致敏肾移植受者的HLA抗体水平,增加肾移植手术的成功率;但其可能增加受者感染和骨髓抑制的风险,需引起进一步的重视。

ObjectiveTo explore the clinical efficacy of immunoadsorption in highly sensitized kidney transplant(KT)candidates.MethodsFrom September 2019 to April 2023,the relevant clinical data were retrospectively reviewed for 26 highly sensitized KT recipients.Protein A immunoadsorption desensitization therapy was offered after KT.The effect of immunosorbent on reducing anti-human leukocyte antigen(HLA)antibodies was summarized.And operative success rate and postoperative complication incidence were calculated.ResultsThe mean number of treatment session was(10.76±5.53).The highest level of HLA-Ⅰantibody mean fluorescence intensity(MFI)dropped from(17921±4442)to(7333±6434)with a decline of 59%and HLA-Ⅱantibody MFI decreased from(21135±5245)to(10989±7627)with a decline of 48%.The differences were statistically significant(both P<0.001).All kidneys were harvested from cadavers.The complications were acute antibody mediated rejection(7 cases),perioperative pulmonary infection(3 cases)and myelosuppression(2 cases).The average follow-up period was(30.8±12.6)month.The graft survival rate was 88.5%(23/26)and the recipient survival rate 100%(26/26).ConclusionsImmunoadsorption therapy can effectively reduce HLA antibody in highly sensitized KT candidates,thereby increasing the probability of successful KT.In terms of safety,immunosorbent therapy may boost the potential risks of infection and myelosuppression.It requires heightened attention.