CAJ | 학술논문

目的探讨对高致敏受者再次进行肾移植的方法.方法 3例高致敏受者再次肾移植术前选择合适的供者,包括亲属活体供肾,供受者间HLA配型良好,淋巴细胞毒交叉配型试验结果均为1％,供者特异性抗体检测阴性.免疫抑制方案采用他克莫司+吗替麦考酚酯+泼尼松三联方案并分别联合利妥昔单抗、抗胸腺细胞球蛋白、巴利昔单抗治疗.脱敏方案采用血浆置换或免疫吸附或血浆置换+低剂量静脉用免疫球蛋白.结果 3例手术均成功,受者无排斥反应发生,术后1～3d血清肌酐降至正常.3例受者随访29～42个月人肾均存活,术后未发生病毒感染及肺炎,无肝功能损害发生.结论良好的HLA配型和避免供者特异性抗体是高致敏患者再次肾移植成功的关键.采用巴利昔单抗、抗胸腺细胞球蛋白、利妥昔单抗及脱敏治疗可以减少排斥反应的发生.
목적 탐토대고치민수자재차진행신이식적방법.방법 3례고치민수자재차신이식술전선택합괄적공자,포괄친속활체공신,공수자간HLA배형량호,림파세포독교차배형시험결과균위1％,공자특이성항체검측음성.면역억제방안채용타극막사+마체맥고분지+발니송삼련방안병분별연합리타석단항、항흉선세포구단백、파리석단항치료.탈민방안채용혈장치환혹면역흡부혹혈장치환+저제량정맥용면역구단백.결과 3례수술균성공,수자무배척반응발생,술후1～3d혈청기항강지정상.3례수자수방29～42개월인신균존활,술후미발생병독감염급폐염,무간공능손해발생.결론 량호적HLA배형화피면공자특이성항체시고치민환자재차신이식성공적관건.채용파리석단항、항흉선세포구단백、리타석단항급탈민치료가이감소배척반응적발생.
Objective To evaluate the safety and efficacy of kidney retransplantation in highlysensitized patients.Methods A total of 3 highly-sensitized patients received living donor kidney retransplantation.HLA was matched very well and complement dependent cytotoxity test was 1％.The donor-specific anti-HLA antibodies were negative. The protocol of anti-rejection therapy comprised tacrolimus,mycophenolate mofetil,and steroid,as well as basiliximab,anti-thymocyte globulin,or rituximab.Desensitization was carried out with plasmapheresis or immunoadsorption,or plasmapheresis combined with intravenous immunoglobulin.Results All the retransplants were successful with renal function back to normal in 1 to 3 days after surgeries.No hyperacute rejection and acute rejection occurred,and no infection and impaired liver function was noted.Conclusion In highly-sensitized patients with retransplantation,a good matching of HLA and avoidance of specific antibodies before operation are important factors for success. Therapy with basiliximab,anti-thymocyte globulin, plasmapheresis,intravenous immunoglobulin,and rituximab may effectively reduce the incidence of rejection.