目的:临床上预存供者特异性抗体(donor specific antibody,DSA)患者术后易发生抗体介导的排斥反应(antibody-mediated rejection,AMR),术后发生并发症和移植失败的风险相对较高。本研究旨在探讨DSA阳性肾移植临床治疗效果并分析术前预...目的:临床上预存供者特异性抗体(donor specific antibody,DSA)患者术后易发生抗体介导的排斥反应(antibody-mediated rejection,AMR),术后发生并发症和移植失败的风险相对较高。本研究旨在探讨DSA阳性肾移植临床治疗效果并分析术前预处理在DSA阳性肾移植中的作用与安全性,为临床DSA阳性肾移植提供单中心治疗经验。方法:回顾性分析郑州大学第一附属医院肾移植科的15例DSA阳性肾移植患者的临床资料,8例为公民逝世后器官捐献来源(organ donation after citizen’s death,DCD)肾移植受者,其中3例在术前未作脱敏治疗(DCD未处理组,n=3),5例受者在术前使用利妥昔单抗作脱敏治疗(DCD预处理组,n=5);其余7例为亲属活体供者(living related donors,LRD)肾移植受者,术前接受利妥昔单抗和血浆置换脱敏治疗(LRD预处理组,n=7)。收集受者肾功能,DSA水平变化,并发症发生情况,术后1年、3年及5年受者和移植肾存活情况等,并比较3组患者的恢复情况与术后并发症的差异。结果:15例受者术前群体反应性抗体(panel reactive antibody,PRA)与DSA均为阳性,均使用甲强龙+兔抗人胸腺细胞免疫球蛋白诱导治疗后行肾移植术。DCD未处理组术后均发生DSA水平反弹、移植肾功能延迟恢复(delayed renal graft function,DGF)与排斥反应,通过联合治疗后患者的DSA水平降低,移植肾功能恢复正常;DCD预处理组均未发生抗体反弹,1例受者出现DGF,接受血浆置换治疗后肾功能恢复正常,余4例受者均于术后2周内肾功能恢复至正常;LRD预处理组中2例发生DSA水平反弹,1例出现排斥反应,经治疗后移植肾功能均恢复至正常,DSA维持在低水平。DCD未处理组患者DGF、排斥反应的发生率高于DCD预处理组和LRD预处理组;术后血尿、蛋白尿、细菌真菌感染发生率及BK病毒感染率的差异均无统计学意义(均P>0.05)。在15例受者中,11例随访1年以上,6例3年以上,1例5年以上,受者和移植肾存活率均为100%。结论:经过有效的术前预处理进行脱敏治疗能够有效预防DSA阳性肾移植抗体反弹,减少围手术期并发症的发生。展开更多
Background: Pre-eclampsia has long been considered as a disease that disappears after the removal of the placenta. It has now been shown that its symptoms can persist for months after giving birth. Objectives: To stud...Background: Pre-eclampsia has long been considered as a disease that disappears after the removal of the placenta. It has now been shown that its symptoms can persist for months after giving birth. Objectives: To study the evolution of proteinuria and renal function in women with pre-eclampsia. Patients and Methods: An analytical prospective study was carried out in the Hospitalization Unit of the Gynecology Department of the Teaching Hospital of Cocody (Abidjan) from May 3, 2021 to November 15, 2021. It focused on the follow-up of proteinuria and renal function in 50 women who had pre-eclampsia during their pregnancy, in the three months following their delivery. Results: The average age of the patients was 30.38 ± 6 years (range 18 and 40 years). Thirty-two percent were nulliparous and 62% had no risk factors for pre-eclampsia. The diagnosis of pre-eclampsia was made in 52% of cases before 37 weeks of amenorrhea. Sixty-two percent had Grade 3 arte-rial hypertension. The average proteinuria/creatininuria ratio was 3592.08 ± 7009.57 mg/g and 32% of women had glomerular grade proteinuria. The mean serum creatinine was 13.61 ± 12.62 mg/l. AKI (Acute Renal Failure) was present in 30% of women. All patients had received a central antihypertensive drug of which 88% were a calcium channel blocker. For the delivery mode, a Caesarean section was performed in 88% of cases. In the three months postpartum, 40% of women had persistent hypertension, 58% had persistent proteinuria and 6% had persistent impaired renal function. Prematurity (p = 0.0091), IUGR (intrauterine growth restriction) (p = 0.0012) and IUFD (intrauterine fetal death) (p = 0.0012) were associated with the persistence of proteinuria at M3 postpartum. Conclusion: Symptoms of pre-eclampsia do not automatically disappear after the delivery. Proteinuria and renal failure can persist beyond three months after the delivery and require treatment by a nephrologist.展开更多
文摘目的:临床上预存供者特异性抗体(donor specific antibody,DSA)患者术后易发生抗体介导的排斥反应(antibody-mediated rejection,AMR),术后发生并发症和移植失败的风险相对较高。本研究旨在探讨DSA阳性肾移植临床治疗效果并分析术前预处理在DSA阳性肾移植中的作用与安全性,为临床DSA阳性肾移植提供单中心治疗经验。方法:回顾性分析郑州大学第一附属医院肾移植科的15例DSA阳性肾移植患者的临床资料,8例为公民逝世后器官捐献来源(organ donation after citizen’s death,DCD)肾移植受者,其中3例在术前未作脱敏治疗(DCD未处理组,n=3),5例受者在术前使用利妥昔单抗作脱敏治疗(DCD预处理组,n=5);其余7例为亲属活体供者(living related donors,LRD)肾移植受者,术前接受利妥昔单抗和血浆置换脱敏治疗(LRD预处理组,n=7)。收集受者肾功能,DSA水平变化,并发症发生情况,术后1年、3年及5年受者和移植肾存活情况等,并比较3组患者的恢复情况与术后并发症的差异。结果:15例受者术前群体反应性抗体(panel reactive antibody,PRA)与DSA均为阳性,均使用甲强龙+兔抗人胸腺细胞免疫球蛋白诱导治疗后行肾移植术。DCD未处理组术后均发生DSA水平反弹、移植肾功能延迟恢复(delayed renal graft function,DGF)与排斥反应,通过联合治疗后患者的DSA水平降低,移植肾功能恢复正常;DCD预处理组均未发生抗体反弹,1例受者出现DGF,接受血浆置换治疗后肾功能恢复正常,余4例受者均于术后2周内肾功能恢复至正常;LRD预处理组中2例发生DSA水平反弹,1例出现排斥反应,经治疗后移植肾功能均恢复至正常,DSA维持在低水平。DCD未处理组患者DGF、排斥反应的发生率高于DCD预处理组和LRD预处理组;术后血尿、蛋白尿、细菌真菌感染发生率及BK病毒感染率的差异均无统计学意义(均P>0.05)。在15例受者中,11例随访1年以上,6例3年以上,1例5年以上,受者和移植肾存活率均为100%。结论:经过有效的术前预处理进行脱敏治疗能够有效预防DSA阳性肾移植抗体反弹,减少围手术期并发症的发生。
文摘Background: Pre-eclampsia has long been considered as a disease that disappears after the removal of the placenta. It has now been shown that its symptoms can persist for months after giving birth. Objectives: To study the evolution of proteinuria and renal function in women with pre-eclampsia. Patients and Methods: An analytical prospective study was carried out in the Hospitalization Unit of the Gynecology Department of the Teaching Hospital of Cocody (Abidjan) from May 3, 2021 to November 15, 2021. It focused on the follow-up of proteinuria and renal function in 50 women who had pre-eclampsia during their pregnancy, in the three months following their delivery. Results: The average age of the patients was 30.38 ± 6 years (range 18 and 40 years). Thirty-two percent were nulliparous and 62% had no risk factors for pre-eclampsia. The diagnosis of pre-eclampsia was made in 52% of cases before 37 weeks of amenorrhea. Sixty-two percent had Grade 3 arte-rial hypertension. The average proteinuria/creatininuria ratio was 3592.08 ± 7009.57 mg/g and 32% of women had glomerular grade proteinuria. The mean serum creatinine was 13.61 ± 12.62 mg/l. AKI (Acute Renal Failure) was present in 30% of women. All patients had received a central antihypertensive drug of which 88% were a calcium channel blocker. For the delivery mode, a Caesarean section was performed in 88% of cases. In the three months postpartum, 40% of women had persistent hypertension, 58% had persistent proteinuria and 6% had persistent impaired renal function. Prematurity (p = 0.0091), IUGR (intrauterine growth restriction) (p = 0.0012) and IUFD (intrauterine fetal death) (p = 0.0012) were associated with the persistence of proteinuria at M3 postpartum. Conclusion: Symptoms of pre-eclampsia do not automatically disappear after the delivery. Proteinuria and renal failure can persist beyond three months after the delivery and require treatment by a nephrologist.
