血浆置换治疗对高敏患者肾移植后排斥反应的影响

Influence of plasma exchange therapy on renal transplant rejection in highly sensitive recipients

目的 探讨血浆置换(PE)减少高敏患者肾移植后排斥反应的疗效。方法 46例肾移植前群体反应性抗体(PRA)阳性≥30%(30%～88%)患者,先作血浆置换治疗1～3次后,当PRA<30％才作尸体肾移植作治疗组。30例PRA阳性,强度≥30％(30％～77％)患者进行尸体肾移植作对照组。比较2组患者术后6个月内排斥反应情况。结果 对照组术后排斥反应发生率为63.3％(19/30)。治疗组移植后排斥反应发生率为21.7%(10/46),(P<0.001)。结论 PE治疗能明显减少有预先形成抗体的高敏患者的肾移植后排斥反应,疗效满意。

Objective To investigate the effect of plasma exchange(PE) therapy on reducing renal transplantation rejection in highly sensitive recipients. Methods Rejections within 6 months after renal transplantation were compared between the two groups of patients,one of which was composed of 30 recipients whose panel reactive antibody levels before the transplantation were from 30% to 77% ,and another was composed of 46 recipients whose panel reactive antibody levels were from 30% to 88%. The later group of patients received PE therapy before transplantation and had not undergone renal transplantation operation until their panel reactive antibody levels were below 30% or negative. Results After transplantation,the rejection incidence was 63. 3% (19/30) for those 30 recipients without plasma exchange therapy and 21.7% (10/46) for the 46 recipients receiving plasma exchange therapy respectively. The difference was very significant(P<0.001). Conclusion For the highly sensitive recipients who have the pre-transplant antibodies,plasma exchange therapy can significantly reduce the post - transplant rejection incidence.