肾移植术后慢性活动性抗体介导排斥反应的激素冲击治疗效果分析

Effect of methylprednisolone pulse therapy on chronic active antibody-mediated rejection after kidney transplantation

目的观察并分析激素冲击治疗肾移植术后慢性活动性抗体介导排斥反应(caAMR)的效果。方法肾移植术后caAMR的40例,将未接受血浆置换+静脉注射免疫球蛋白(IVIG)、美罗华治疗的患者26例根据是否仅接受激素冲击治疗,分为单纯激素治疗组12例与非激素治疗组14例;将接受血浆置换+IVIG或美罗华治疗的患者14例根据是否同时接受激素冲击治疗分为激素联合治疗组6例与其他治疗组8例;将纳入研究的所有患者(40例)根据是否接受激素冲击治疗,分为激素治疗组18例与对照组22例。根据治疗后肌酐与eGFR变化评估移植肾功能,计算治疗后6个月的肌酐斜率与eGFR斜率。记录治疗后6个月感染性并发症的发生率。随访至2023年7月31日或移植肾失功,记录各组移植肾预后情况。结果单纯激素治疗组移植肾中位存活时间长于非激素治疗组(P<0.05)。其他治疗组、激素联合治疗组移植肾中位存活时间差异无统计学意义(P>0.05)。激素治疗组治疗后6个月肌酐斜率低于对照组,eGFR斜率高于对照组,移植肾中位存活时间长于对照组(P均<0.05)。结论激素冲击治疗肾移植术后caAMR可延缓移植肾功能减退,延长移植肾存活时间,尤其对于合并急性肾损伤指标升高的患者效果更明显。

Objective To observe and analyze the effect of methylprednisolone pulse therapy on chronic active antibody-mediated rejection(caAMR)in kidney transplant recipients.Methods Among the 40 patients diagnosed with caAMR following kidney transplantation,26 patients who did not undergo plasma exchange combined with intravenous immunoglobulin(IVIG)and rituximab were categorized into two groups:the methylprednisolone therapy group of 12 patients receiving methylprednisolone therapy alone and the non-methylprednisolone therapy group of 14 patients,based on whether they received methylprednisolone pulse therapy or not;the remaining 14 patients who underwent plasma exchange along with IVIG or rituximab were further divided into the methylprednisolone combination therapy group(6 cases)and the other treatment group(8 cases),depending on their receipt of methylprednisolone pulse therapy.All participants in this study(40 cases)were classified into the methylprednisolone therapy group(18 cases)and the control group(22 cases),according to their administration of methylprednisolone pulse therapy.Kidney allograft function was evaluated by monitoring the changes in creatinine levels and estimated glomerular filtration rate(eGFR)after treatment,with calculations made for both creatinine slope and eGFR slope at six months after treatment.The incidence of infectious complications at six month after treatment was recorded.Follow-up continued until July 31,2023,or until kidney allograft failure occurred,during which the prognosis of renal grafts within each cohort was recorded.Results The median survival time of allograft kidney in the methylprednisolone therapy alone group was significantly longer than that in the non-methylprednisolone therapy group(P<0.05).No significant difference was found in the median survival time of allograft kidney between the methylprednisolone combination therapy group and other treatment group(P>0.05).At six months after treatment,the creatinine slope in the methylprednisolone therapy group was lower than that of the control group,while the eGFR slope was higher in comparison with that of the control group;additionally,the median survival time of allograft kidney was longer than that in the control group(all P<0.05).Conclusions Methylprednisolone pulse therapy in caAMR patients can delay the decline of kidney allograft function and prolong the kidney allograft survival,especially for patients with elevated indicators of acute kidney injury.