高度致敏受者的肾移植术

Renal transplantation in highly sensitized patients

目的 探讨高度致敏肾移植受者的组织配型和抗排斥治疗方案。方法 回顾性分析4 5例高度致敏肾移植受者的HLA抗体、HLA配型和肾移植后抗排斥反应治疗效果。结果 肾移植术后发生超急性排斥反应 2例 (4.4 % ) ,急性排斥反应 9例 (2 0 .9% ) ,经激素、抗胸腺细胞球蛋白、血浆置换等治疗后均逆转。人 /肾 1年存活率分别为 95 .6 % /91.1%。结论 避开相应抗体的良好HLA配型 ,是高度致敏受者肾移植成功的关键。术后采用抗胸腺细胞球蛋白短程诱导、并用他克莫司、霉酚酸酯治疗 ,能减少急性排斥的发生率 ,提高移植物的存活率。

Objective To explore the protocol of tissue matching and anti-rejection therapy in highly sensitized patients (HSP). Method The panel reactive antibody (PRA), human leukocyte antigen (HLA) matching and renal transplantation outcomes of 45 HSPs were retrospectively analyzed. Results Hyperacute rejection occurred in 2 patients. Acute rejection occurred in 9 patients and reversed by anti-rejection therapy. One year patient/graft survival rate was 95.6% / 91.1% respectively. Conclusions To avoid specific antibody through HLA matching is the key point for successful renal transplantation of HSP. Antithymocyte globulin (ATG) induction therapy combined with tacrolimus, mycophenolate mofetil therapy can decrease the rate of acute rejection and prolong graft survival.