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ABO血型不相容亲属活体肾移植的个体化预处理

Application of individualized protocols to reduce ABO antibodies in ABO-incompatible living donor kidney transplantation

摘要:

目的 探讨个体化预处理方法在ABO血型不相容亲属活体肾移植中应用的临床疗效和安全性.方法 以2014年9月至2015年7月间于四川大学华西医院泌尿外科接受ABO血型不相容亲属活体肾移植的6例为研究对象.受者中男性5例,女性1例;B型供O型3例,AB型供B型1例,AB型供A型1例,A型供O型1例.根据受者的初始血型抗体效价,采用单用口服免疫抑制剂或者是口服免疫抑制剂并加上血浆置换、血浆双重滤过、利妥昔单抗等方法来个体化预处理,并监测预处理前、预处理后、肾移植术前及术后的血型抗体效价和其他相关指标.结果 经过个体化预处理后,6例受者在移植手术当天血型抗体IgM、IgG效价水平均≤1∶8,术后2周内无血型抗体效价的反弹(>1∶8).围手术期发生急性排斥反应1例次、切口脂肪液化1例次、急性肾小管坏死1例次、骨髓抑制1例次、肺部感染1例次,经过积极的治疗均痊愈.所有受者在围手术期都未出现凝血功能障碍(出血倾向或血栓形成).6例受者均存活良好,生活质量明显提高,移植肾功能正常.结论根据受者初始血型抗体效价水平个体化选用血浆置换、血浆双重滤过、利妥昔单抗等方法结合免疫抑制治疗,可安全、有效的实施ABO血型不相容亲属活体肾移植.

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Objective To investigate the clinical efficacy and safety of individualized preconditioning to reduce ABO antibodies in ABO-incompatible living donor kidney transplantation.Method A series of six living donor kidney transplants across a range of ABO blood group incompatibilities using individualized preconditioning protocols to reduce ABO antibodies were obtained from September 2014 to July 2015 in West China Hospital,Sichuan University.Preconditioning included tacrolimus,mycophenolate acid and prednisolone with/without the administration of rituximab,plasma exchange or double filtration plasmapheresis.Medical records and electronic databases were reviewed for isoagglutinin titers,patient and graft survival,graft function,rate of rejections,infections as well as for surgical complications.Result Of the six ABOincompatible recepients,there was one female,and five males.ABO blood group incompatibilities were B to O (n =3),AB to B (n =1),AB to A (n =1),and A to O (n =1).After individualized preconditioning,an acceptable isoagglutinin titer (≤1∶8) was obtained on the date of transplantation,and no recepients of isoagglutinin titers rebounded (>1∶8) within two weeks after transplantation.In total,there was one episode of acute rejection,wound fat liquefaction,acute tubular necrosis,bone marrow suppression and pneumonia in the perioperative period.These complications were well cured after active therapy.No recipients experienced blood coagulation disorders (bleeding tendency/thrombosis) perioperatively.Six recepients were all in excellent physical and mental condition with stale graft fucntion at the recent follow-up.Conclusion Our results indicate that individualized preconditioning protocols to reduce ABO antibodies based on initial titers are technically feasible and lead to excellent short-term survival of ABO-incompatible living donor kidney transplantation.

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