中华器官移植杂志
中華器官移植雜誌
중화기관이식잡지
CHINESE JOURNAL OF ORGAN TRANSPLANTATION
2013年
4期
209-213
,共5页
李龙%戚贵生%杨橙%林淼%赵梓彤%吴擘頲%唐群业%许明%戎瑞明
李龍%慼貴生%楊橙%林淼%趙梓彤%吳擘頲%唐群業%許明%戎瑞明
리룡%척귀생%양등%림묘%조재동%오벽정%당군업%허명%융서명
肾移植%致敏%移植物排斥%抗体%淋巴照射%血浆置换%T淋巴细胞,调节
腎移植%緻敏%移植物排斥%抗體%淋巴照射%血漿置換%T淋巴細胞,調節
신이식%치민%이식물배척%항체%림파조사%혈장치환%T림파세포,조절
Kidney transplantation%Sensitization%Graft rejection%Antibodies%Lymphatic irradiation%Plasma exchange%T-Lymphocytes,regulatory
目的 探讨全身淋巴照射联合抗胸腺细胞球蛋白(ATG)用于高致敏患者肾移植脱敏治疗及移植后抗体介导的排斥反应(AMR)治疗的效果.方法 回顾性分析2009-2011年间13例肾移植受者的资料,其中2例为术前致敏患者,均接受全身淋巴照射+血浆置换+低剂量静脉注射丙种球蛋白(IVIG)+ ATG的脱敏方案；11例为经移植肾穿刺病理检查诊断的AMR,7例接受全身淋巴照射+血浆置换+低剂量IVIG+ ATG的治疗方案,4例接受全身淋巴照射+MG+ ATG的治疗方案.结果 术前脱敏治疗2例均治疗成功,并接受活体供肾移植,术后随访1年未出现病理证实的急性排斥反应,术后B淋巴细胞数量呈持续抑制趋势,随访期间未超过脱敏治疗前水平,术后各时间点调节性T淋巴细胞(Treg细胞)百分率较脱敏治疗前明显升高.术后AMR患者中,10例治疗后排斥反应成功逆转,1例因治疗失败行移植肾切除.治疗成功的AMR患者外周血B淋巴细胞比例及绝对数呈持续抑制趋势,Treg细胞百分率较治疗前明显升高,治疗后1年行移植肾程序性活检均未发现AMR.结论 全身淋巴照射联合ATG用于高致敏患者的脱敏治疗及肾移植受者AMR治疗,具有较好的临床效果,其机制可能与诱导Treg细胞的产生有关.
目的 探討全身淋巴照射聯閤抗胸腺細胞毬蛋白(ATG)用于高緻敏患者腎移植脫敏治療及移植後抗體介導的排斥反應(AMR)治療的效果.方法 迴顧性分析2009-2011年間13例腎移植受者的資料,其中2例為術前緻敏患者,均接受全身淋巴照射+血漿置換+低劑量靜脈註射丙種毬蛋白(IVIG)+ ATG的脫敏方案；11例為經移植腎穿刺病理檢查診斷的AMR,7例接受全身淋巴照射+血漿置換+低劑量IVIG+ ATG的治療方案,4例接受全身淋巴照射+MG+ ATG的治療方案.結果 術前脫敏治療2例均治療成功,併接受活體供腎移植,術後隨訪1年未齣現病理證實的急性排斥反應,術後B淋巴細胞數量呈持續抑製趨勢,隨訪期間未超過脫敏治療前水平,術後各時間點調節性T淋巴細胞(Treg細胞)百分率較脫敏治療前明顯升高.術後AMR患者中,10例治療後排斥反應成功逆轉,1例因治療失敗行移植腎切除.治療成功的AMR患者外週血B淋巴細胞比例及絕對數呈持續抑製趨勢,Treg細胞百分率較治療前明顯升高,治療後1年行移植腎程序性活檢均未髮現AMR.結論 全身淋巴照射聯閤ATG用于高緻敏患者的脫敏治療及腎移植受者AMR治療,具有較好的臨床效果,其機製可能與誘導Treg細胞的產生有關.
목적 탐토전신림파조사연합항흉선세포구단백(ATG)용우고치민환자신이식탈민치료급이식후항체개도적배척반응(AMR)치료적효과.방법 회고성분석2009-2011년간13례신이식수자적자료,기중2례위술전치민환자,균접수전신림파조사+혈장치환+저제량정맥주사병충구단백(IVIG)+ ATG적탈민방안；11례위경이식신천자병리검사진단적AMR,7례접수전신림파조사+혈장치환+저제량IVIG+ ATG적치료방안,4례접수전신림파조사+MG+ ATG적치료방안.결과 술전탈민치료2례균치료성공,병접수활체공신이식,술후수방1년미출현병리증실적급성배척반응,술후B림파세포수량정지속억제추세,수방기간미초과탈민치료전수평,술후각시간점조절성T림파세포(Treg세포)백분솔교탈민치료전명현승고.술후AMR환자중,10례치료후배척반응성공역전,1례인치료실패행이식신절제.치료성공적AMR환자외주혈B림파세포비례급절대수정지속억제추세,Treg세포백분솔교치료전명현승고,치료후1년행이식신정서성활검균미발현AMR.결론 전신림파조사연합ATG용우고치민환자적탈민치료급신이식수자AMR치료,구유교호적림상효과,기궤제가능여유도Treg세포적산생유관.
Objective To explore the availability and safety of combined TLI and Low-dose ATG as desensitization protocol in highly sensitized or antibody-mediated rejection (AMR) renal allograft recipients and the potential mechanisms.Method Thirteen sensitized patients were enrolled in the study from 2009 to 2011.Their clinical data were collected.Two of 13 cases were defined as pre-transplantation sensitized group,who received combined therapy of TLI,PP,low-dose of IVIG,and ATG induction.Eleven cases were diagnosed as AMR proven by allograft biopsy:7 cases received combined therapy of TLI,PP,low-dose IVIG,and ATG,and 4 cases were given combined therapy of TLI,low dose of IVIG,and ATG.Result Two pre-transplantation sensitized cases were successfully desensitized,and received renal transplantation later.After desensitization,their peripheral B cell levels were persistently down-regulated,and the percentages of regulatory T cells were higher than those before desensitization at several time points.For AMR cases,similar trends were observed except that only 1 case failed in the therapy and lost allograft.Renal allograft biopsy at 1 year checkpoint showed no AMR in these cases successfully cured.Conclusion Combined therapy of TLI and low-dose ATG is an effective pathway for desensitization or AMR reversal.Further research demonstrated its effect on inducing Tregs.
