CAJ | 학술논문

目的总结活体肾移植前对致敏患者的处理经验,并对移植效果进行分析.方法回顾性分析609例活体肾移植受者的临床资料.根据移植前群体反应性抗体(PRA)水平将受者分为高致敏组(41例,PRA≥30％),低致敏组(102例,PRA为0～30％)和非致敏组(466例,PRA为0).所有受者经HLA抗体检测和淋巴细胞毒交叉配合试验(CDC)确认没有针对供者的HLA抗体后进行肾移植.高致敏组给予抗胸腺细胞球蛋白诱导治疗,低致敏组给予抗白细胞介素2受体单抗诱导治疗.随访1年以上,观察各组术后移植肾功能、急性排斥反应发生率、受者和移植肾存活率及并发症发生率.结果高致敏组、低致敏组和非致敏组受者术后移植肾恢复正常的时间和1年时肾小球滤过率均无明显差异；3组均未发生超急性排斥反应,急性排斥反应发生率分别为9.76％(4/41)、8.82％(9/102)和8.15％(38/466),术后1年移植肾存活率分别为97.6％(40/41)、97.1％(99/102)和98.1％(457/466),受者存活率分别为97.6％(40/41)、98.0％(100/102)和98.9％(461/466),3组间上述指标的差异均无统计学意义(P＞0.05).高致敏组的感染发生率为31.7％(13/41),明显高于低致敏组的26.5％(27/102)和非致敏组的21.6％ (101/466) (P＜0.05).结论致敏受者肾移植前经HLA抗体检测和CDC配型,避开受者体内供者特异性抗体针对的供肾,并给予免疫诱导治疗,可以获得与非致敏受者相似的良好效果.
목적 총결활체신이식전대치민환자적처리경험,병대이식효과진행분석.방법 회고성분석609례활체신이식수자적림상자료.근거이식전군체반응성항체(PRA)수평장수자분위고치민조(41례,PRA≥30％),저치민조(102례,PRA위0～30％)화비치민조(466례,PRA위0).소유수자경HLA항체검측화림파세포독교차배합시험(CDC)학인몰유침대공자적HLA항체후진행신이식.고치민조급여항흉선세포구단백유도치료,저치민조급여항백세포개소2수체단항유도치료.수방1년이상,관찰각조술후이식신공능、급성배척반응발생솔、수자화이식신존활솔급병발증발생솔.결과 고치민조、저치민조화비치민조수자술후이식신회복정상적시간화1년시신소구려과솔균무명현차이；3조균미발생초급성배척반응,급성배척반응발생솔분별위9.76％(4/41)、8.82％(9/102)화8.15％(38/466),술후1년이식신존활솔분별위97.6％(40/41)、97.1％(99/102)화98.1％(457/466),수자존활솔분별위97.6％(40/41)、98.0％(100/102)화98.9％(461/466),3조간상술지표적차이균무통계학의의(P＞0.05).고치민조적감염발생솔위31.7％(13/41),명현고우저치민조적26.5％(27/102)화비치민조적21.6％ (101/466) (P＜0.05).결론 치민수자신이식전경HLA항체검측화CDC배형,피개수자체내공자특이성항체침대적공신,병급여면역유도치료,가이획득여비치민수자상사적량호효과.
Objective To summarize the management experience of sensitized recipients before living kidney transplantation and to analyze the effect.Method A retrospective analysis was done on the clinical data of 609 cases of living kidney transplant recipients.According to the pretransplant panel reactive antibody (PRA),we allocated them into highly sensitized group (41 cases,PRA ≥ 30％),low sensitized group (102 cases,PRA 0-30％) and non-sensitized group (466 cases,PRA=0).All cases were confirmed with no anti-donor HLA antibodies by HLA antibody detection and complement-dependent cytotoxicity (CDC) before transplantation.The recipients inhighly sensitized group were treated with anti-thymoglobulin (ATG) as induction therapy,while those in low sensitized group were given IL-2R antibody (IL-2Ra).Renal function,incidence of acute rejection (AR),patient and graft survival rate,and complications were observed upon 1-year follow-up.Result There was no significant difference in renal function recovery time and eGFR at 1 year among highly sensitized,low sensitized and nonsensitized groups.In highly sensitized,low sensitized and nonsensitized groups,the incidence of AR was 9.76％ (4/41),8.82％ (9/102) and 8.15％ (38/466),1-year graft survival rate was 97.6％ (40/41),97.1％ (99/102) and 98.1％ (457/466),and 1-year patient survival rate was 97.6％ (40/41),98.0％ (100/102) and 98.9％ (461/466),respectively,with the difference being not statistically significant among these three groups (P＞0.05).Infection rate in highly sensitized group was 31.7％ (13/41),which was significantly higher than in low sensitized group (26.5％,27/102) and non-sensitized group (21.6％,101/466) (P＜0.05).Conclusion Avoiding donors with donor special antigen (DSA) by HLA antibody detection and CDC before kidney transplantation,and sensitized recipients with induction therapy can share similar well effect to non-sensitized recipients.