抗淋巴细胞制剂诱导治疗对肾移植后人、肾长期存活的影响

目的 探讨抗淋巴细胞制剂诱导治疗对肾移植后人、肾长期存活的影响.方法 271例首次接受尸体肾移植的受者,其中使用抗胸腺细胞球蛋白诱导治疗者110例(ATG组),使用巴利昔单抗诱导治疗者88例(Bax组),未接受诱导治疗者73例(对照组).所有受者术后采用他克莫司+吗替麦考酚酯+皮质激素的三联免疫抑制方案,并应用更昔洛韦预防CMV感染.术后对所有受者进行了1~5年的随访,观察和比较各组术后6个月内的并发症发生情况,以及术后1、3、5年的人、肾存活率.结果 ATG组、Bax组和对照组术后6个月AR的发生率分别为9.1 %(10/110)、10.2 %(9/88)和17.8 %(13/73),ATG组和Bax组间AR发生率的差异无统计学意义(P＞0.05),但均显著低于对照组(P＜0.05).3组间移植肾功能恢复延迟、CMV感染及非CMV感染等发生率的比较,差异均无统计学意义(P＞0.05).ATG组和Bax组术后1、3、5年移植肾存活率分别为95.5 %、90.9 %、87.3 %和93.2 %、87.5 %、83.8 %,均显著高于对照组的87.7 %、80.8 %、75.3 %(P＜0.05).结论 应用抗淋巴细胞制剂进行免疫诱导治疗可显著降低肾移植术后早期AR的发生率,并显著改善移植肾的长期存活率.

Abstract：

Objective To explore the impact of induction therapy with anti-lymphocyte agents on long-term survival of kidney transplantation.Methods 271 recipients of first cadaveric kidney transplants were treated with tacrolimus,mycophenolate mofetil and prednisone.110 patients of them received induction therapy with anti-thymocyte globulin(ATG group),88 patients received Basiliximab(Bax group),and the remaining 73 patients did not receive induction therapy(control group).The data of AR,DGF,CMV infection,and 1- 3- 5-year patient/allograft survival rate in three groups were retrospectively during a follow-up period of 1 to 5 years postoperatively.Results Within 6 months after operation,the incidence of AR in control group,ATG group and Bax group was 17.8 %(13/73),9.1 %(10/110)and 10.2 %(9/88)respectively.The incidence of AR in ATG group and Bax group was significantly lower than in control group (P<0.05).There was no significant difference in incidence of DGF and CMV infection among three groups.The 1-,3- and 5-year allograft survival rate postoperation in ATG group and Bax group was 95.5 %,90.9 %,87.3 % and 93.2 %,87.5 %,83.8 % respectively,which was significantly higher than in control group(87.7 %,80.8 % and 75.3 %,P<0.05).Conclusion Induction therapy with anti-lymphocyte agents may reduce the early incidence of AR and prolong long-term allograft survival significantly.     

影响肾移植后人、肾长期存活的因素分析

目的　分析肾移植后影响人、肾长期存活的因素。方法　采用SAS软件 ,统计 2 0 16例2 10 5次肾移植患者中的 33个相关变量。用Kaplan Meier曲线计算移植肾 1、3、5、10年存活率及移植肾半生存期 ,用Log Rank方法进行单变量分析 ,采用Cox模型多元回归计算相对危险度。 结果　1986年以后 ,移植肾 1、3、5、10年存活率分别为 82 .5 %、75 .2 %、6 5 .5 %、4 8.4 % ,剔除有移植肾功能死亡的病例后 ,存活率则为 91.0 %、82 .0 %、75 .9%、6 8.5 % ,两者的移植肾半生存期分别为(8.78± 0 .14 )年和 (14 .0 9± 0 .2 0 )年。与肾移植长期存活关系密切的单变量有 :供肾冷缺血时间 ,移植次数 ,免疫抑制用药种类和组合 ,排斥 ,移植肾功能恢复正常的时间及术后肌酐水平 ,急性肾小管坏死 ,移植肾功能恢复延迟 ,急性排斥反应的治疗方法 ,感染并发症等。多变量分析发现 ,有 18项危险因素影响肾移植后的人、肾长期存活。结论　免疫抑制剂的改进不但提高肾移植后的人、肾短期存活 ,也显示出提高长期存活的趋势 ;提高供肾质量 ,减少受者带肾功能死亡是现阶段提高移植肾长期存活率的一个可实现途径。     

肾移植后采用巴利昔单抗诱导治疗时的感染及预防

Objective To investigate the incidence of infection and the effect of anti-infection prophylaxis in renal transplanted patients after Basiliximab induction therapy. Methods A total of 204patients who have received renal transplantation and Basiliximab induction therapy from January 1,2001 to December 31, 2010 in our hospital have been retrospective analysed in this study. These patients were divided into a prophylaxis group (118 cases) with Ganciclovir + Sulfadiazine +Trimethoprim therapy and a control group (86 cases) without any anti-infection prophylaxis.Furthermore, 440 transplanted patients in the same peroid without any induction therapy were also analysed. They were also devided into two groups: an anti-infection prophylaxis group (206 cases)and a control group (234 cases) without any anti-infection prophylaxis. Results In the prophylaxis group with Basiliximab induction therapy, there were 23 patients (19. 5 %, 23/118)experienced hospitalization due to infection, 3 cases (13. 0 %,3/23) among them were severe infection, and 3patients (13.0 %, 3/23) died from vital infection. In the non-prophylaxis control group with Basiliximab induction therapy, 27 patients (31.4 %, 27/86) had infection complication, 7 patients (25.9 % ,7/27) among them were severe infection, and 4 patients(14. 8 % ,4/27)died. The incidence of infection between the above two groups is significantly different (P＜0. 05). In the prophylaxis group without induction therapy, the incidence of infection was 15.0 % (31/206), there were no severe infection cases but 7 patients (22. 6 %, 7/31) died from infection. In the non-prophylaxis control group without induction therapy, the incidence of infection was 12. 8 % (30/234), 3 cases among them were severe infection(10. 0 %,3/30)and 5 patients died from infection (16. 7 %, 5/30).The incidence of infection in Basiliximab induced patients without anti-infection prophylaxis is significantly higher than that in patients without induction therapy and anti-infection prophylaxis (31.4 % vs. 12.8 %,P＜0.01). Conclusion Basiliximab induction therapy increased the risk of infection, but not the rate of mortality. It is necessary to give anti-infection prophylaxis in renal transplanted patients with Basiliximab induction therapy.     

肾移植后采用巴利昔单抗诱导治疗时的感染及预防

Objective To investigate the incidence of infection and the effect of anti-infection prophylaxis in renal transplanted patients after Basiliximab induction therapy. Methods A total of 204patients who have received renal transplantation and Basiliximab induction therapy from January 1,2001 to December 31, 2010 in our hospital have been retrospective analysed in this study. These patients were divided into a prophylaxis group (118 cases) with Ganciclovir + Sulfadiazine +Trimethoprim therapy and a control group (86 cases) without any anti-infection prophylaxis.Furthermore, 440 transplanted patients in the same peroid without any induction therapy were also analysed. They were also devided into two groups: an anti-infection prophylaxis group (206 cases)and a control group (234 cases) without any anti-infection prophylaxis. Results In the prophylaxis group with Basiliximab induction therapy, there were 23 patients (19. 5 %, 23/118)experienced hospitalization due to infection, 3 cases (13. 0 %,3/23) among them were severe infection, and 3patients (13.0 %, 3/23) died from vital infection. In the non-prophylaxis control group with Basiliximab induction therapy, 27 patients (31.4 %, 27/86) had infection complication, 7 patients (25.9 % ,7/27) among them were severe infection, and 4 patients(14. 8 % ,4/27)died. The incidence of infection between the above two groups is significantly different (P＜0. 05). In the prophylaxis group without induction therapy, the incidence of infection was 15.0 % (31/206), there were no severe infection cases but 7 patients (22. 6 %, 7/31) died from infection. In the non-prophylaxis control group without induction therapy, the incidence of infection was 12. 8 % (30/234), 3 cases among them were severe infection(10. 0 %,3/30)and 5 patients died from infection (16. 7 %, 5/30).The incidence of infection in Basiliximab induced patients without anti-infection prophylaxis is significantly higher than that in patients without induction therapy and anti-infection prophylaxis (31.4 % vs. 12.8 %,P＜0.01). Conclusion Basiliximab induction therapy increased the risk of infection, but not the rate of mortality. It is necessary to give anti-infection prophylaxis in renal transplanted patients with Basiliximab induction therapy.     

肾移植后采用巴利昔单抗诱导治疗时的感染及预防

目的 探讨肾移植后采用巴利昔单抗诱导治疗时的感染发生情况以及采取感染预防措施的效果.方法 回顾分析2001年1月至2010年12月间肾移植后接受巴利昔单抗诱导治疗者的资料,共有204例患者人选,其中118例采取感染预防措施(预防组),余下86例未行感染预防(对照组).同期440例未接受巴利昔单抗以及其他抗体类制剂的肾移植受者,其中234例未采取感染预防措施(无诱导对照组),206例采取了感染预防措施(无诱导预防组).诱导治疗方案为移植术前2 h和术后第4天各滴注巴利昔单抗20mg,感染预防方案为更昔洛韦+联磺甲氧苄啶.分析感染并发症与抗体治疗的关系以及预防感染的效果.结果 204例应用巴利昔单抗诱导治疗者中,预防组23例(19.5%,23/118)因感染需住院治疗,其中重症病例3例(13.0%,3/23),因感染死亡3例(13.0%,3/23);对照组为27例(31.4%,27/86)因感染需住院治疗,其中重症病例7例(25.9%,7/27),因感染死亡4例(14.8%,4/27);预防组和对照组感染发生率的差异有统计学意义(P＜0.05),两组间重症感染率的差异有统计学意义(P＜0.05),而死亡率的差异无统计学意义(P＞0.05).同期肾移植后未行抗体诱导治疗440例,无诱导预防组感染发生率为15.0%(31/206),无重症病例,因感染死亡7例(22.6%,7/31);无诱导对照组感染发生率为12.8%(30/234),其中重症病例3例(10.0%,3/30),因感染死亡5例(16.7%,5/30).在未采取感染预防措施的情况下,采用抗体诱导治疗者的感染发生率(31.4%)明显高于无诱导者(12.8%),差异有统计学意义(P＜0.01).结论 肾移植后应用巴利昔单抗诱导治疗存在感染风险,但不增加死亡率;联合采取感染预防措施可以降低感染发生率和重症感染率,能有效预防感染并发症.

Abstract：

Objective To investigate the incidence of infection and the effect of anti-infection prophylaxis in renal transplanted patients after Basiliximab induction therapy. Methods A total of 204patients who have received renal transplantation and Basiliximab induction therapy from January 1,2001 to December 31, 2010 in our hospital have been retrospective analysed in this study. These patients were divided into a prophylaxis group (118 cases) with Ganciclovir + Sulfadiazine +Trimethoprim therapy and a control group (86 cases) without any anti-infection prophylaxis.Furthermore, 440 transplanted patients in the same peroid without any induction therapy were also analysed. They were also devided into two groups: an anti-infection prophylaxis group (206 cases)and a control group (234 cases) without any anti-infection prophylaxis. Results In the prophylaxis group with Basiliximab induction therapy, there were 23 patients (19. 5 %, 23/118)experienced hospitalization due to infection, 3 cases (13. 0 %,3/23) among them were severe infection, and 3patients (13.0 %, 3/23) died from vital infection. In the non-prophylaxis control group with Basiliximab induction therapy, 27 patients (31.4 %, 27/86) had infection complication, 7 patients (25.9 % ,7/27) among them were severe infection, and 4 patients(14. 8 % ,4/27)died. The incidence of infection between the above two groups is significantly different (P＜0. 05). In the prophylaxis group without induction therapy, the incidence of infection was 15.0 % (31/206), there were no severe infection cases but 7 patients (22. 6 %, 7/31) died from infection. In the non-prophylaxis control group without induction therapy, the incidence of infection was 12. 8 % (30/234), 3 cases among them were severe infection(10. 0 %,3/30)and 5 patients died from infection (16. 7 %, 5/30).The incidence of infection in Basiliximab induced patients without anti-infection prophylaxis is significantly higher than that in patients without induction therapy and anti-infection prophylaxis (31.4 % vs. 12.8 %,P＜0.01). Conclusion Basiliximab induction therapy increased the risk of infection, but not the rate of mortality. It is necessary to give anti-infection prophylaxis in renal transplanted patients with Basiliximab induction therapy.     

肾移植后采用巴利昔单抗诱导治疗时的感染及预防

Objective To investigate the incidence of infection and the effect of anti-infection prophylaxis in renal transplanted patients after Basiliximab induction therapy. Methods A total of 204patients who have received renal transplantation and Basiliximab induction therapy from January 1,2001 to December 31, 2010 in our hospital have been retrospective analysed in this study. These patients were divided into a prophylaxis group (118 cases) with Ganciclovir + Sulfadiazine +Trimethoprim therapy and a control group (86 cases) without any anti-infection prophylaxis.Furthermore, 440 transplanted patients in the same peroid without any induction therapy were also analysed. They were also devided into two groups: an anti-infection prophylaxis group (206 cases)and a control group (234 cases) without any anti-infection prophylaxis. Results In the prophylaxis group with Basiliximab induction therapy, there were 23 patients (19. 5 %, 23/118)experienced hospitalization due to infection, 3 cases (13. 0 %,3/23) among them were severe infection, and 3patients (13.0 %, 3/23) died from vital infection. In the non-prophylaxis control group with Basiliximab induction therapy, 27 patients (31.4 %, 27/86) had infection complication, 7 patients (25.9 % ,7/27) among them were severe infection, and 4 patients(14. 8 % ,4/27)died. The incidence of infection between the above two groups is significantly different (P＜0. 05). In the prophylaxis group without induction therapy, the incidence of infection was 15.0 % (31/206), there were no severe infection cases but 7 patients (22. 6 %, 7/31) died from infection. In the non-prophylaxis control group without induction therapy, the incidence of infection was 12. 8 % (30/234), 3 cases among them were severe infection(10. 0 %,3/30)and 5 patients died from infection (16. 7 %, 5/30).The incidence of infection in Basiliximab induced patients without anti-infection prophylaxis is significantly higher than that in patients without induction therapy and anti-infection prophylaxis (31.4 % vs. 12.8 %,P＜0.01). Conclusion Basiliximab induction therapy increased the risk of infection, but not the rate of mortality. It is necessary to give anti-infection prophylaxis in renal transplanted patients with Basiliximab induction therapy.     

影响致敏受者肾移植术后人/肾存活的相关因素

目的：探讨影响致敏受者肾移植术后人／肾存活的相关因素。方法：对82例致敏受者尸体肾移植患者可能影响移植肾存活相关的20个因素47个水平，进行Logrank单因素分析和Cox模型多因素回归分析。结果：82例的1、2和3年的人存活率分别为98％、96％和94％；移植肾存活率分别为90％、87％和83％。总的移植肾半生存期为4．7年。单因素分析，群体反应抗体水平和动态变化、供体特异性抗体、急性排斥、慢性排斥、冷缺血时间、早期肾功能、血肌酐水平和免疫诱导剂等9个因素；多因素分析，急性排斥、供体特异性抗体和群体反应抗体类型等3个因素；单因素和多因素同时分析，急性排斥和供体特异性抗体2个因素，对致敏受者移植肾短期和长期的存活率有重要的影响(P＜0．05)。结论：高质量的供肾、群体反应抗体动态监测、尽力避免和有效处理术前和术后相关危险因素，对提高致敏受者肾移植的人／肾存活率有重要的作用。     

肾移植术后早期肾功能恢复对人肾长期存活的影响

目的 探讨肾移植术后早期肾功能恢复情况对人肾长期存活的影响。方法 总结1990-1998年652例肾移植患者资料。根据肾功能恢复情况分为3组：肾功能恢复迅速（IGF）组（A组）473例，肾功能恢复缓慢未行透析治疗（SGF）组（B组）82例，肾功能延迟恢复（DGF）组（C组）97例。对3组患者5、10年人。肾存活率及1年急性排斥反应和带肾死亡情况进行比较分析。结果 A组5、10年人／肾存活率分别为74．0％／70．2％、66．9％／60．3％，B组为64．6％／61．0％、62．2％／42．2％，C组为60．8％／43．3％、55．7％／23．0％。5年人存活率A、B组高于C组，5年。肾存活率A组高于C组，5年人／肾存活率A、B组差异无统计学意义。10年人／肾存活率A组〉B组〉C组，差异均有统计学意义。3组1年急性排斥反应发生率为20．1％、30．5％、43．2％，组间差异有统计学意义。3组1年带肾死亡率为4．7％、4．9％、12．4％，A、B组〈C组，A、B组间差异无统计学意义。急性排斥反应和带肾死亡病例排除后进行比较，3组长期存活率差异无统计学意义。结论 肾移植术后早期肾功能恢复情况对移植患者长期人肾存活有明显影响，DGF患者的影响最明显，SGF预后介于IGF和DGF间。SGF和DGF对长期存活的影响可能源于移植早期较高的急性排斥反应或并发症发生率。     

肾移植术后长期存活

作者总结了1960年10月至1974年12月间临床施行肾移植术的127个病例。文中提到肾移植术的适应证、併发症等以及处理和结果。127例中许多病例在肾移植术后存活5年以上,1例存活了12年。故作者等特别着重论及肾移植术后长期存活的问题。病例和处理鉴于长期实践过程中所采取处理措施的改变,作者将全部病例分     

肝移植后采用巴利昔单抗进行免疫诱导治疗

目的 探讨肝移植后采用巴利昔单抗进行免疫诱导治疗预防急性排斥反应的有效性和安全性.方法 160例肝移植患者中,47例术后给予两剂巴利昔单抗(20 mg/剂)进行免疫诱导治疗(研究组),另外113例为对照组,不使用巴利昔单抗.所有患者术后均采用他克莫司、霉酚酸酯和糖皮质激素预防排斥反应.结果 术后1年内,研究组的急性排斥反应发生率为8.5%(4/47),对照组为22.1%(25/113),二者间的差异有统计学意义(P＜0.05);研究组排斥反应活动指数平均为4,对照组为6,两组间的差异无统计学意义(P＞0.05).研究组术后感染发生率为31.9 %(15/47),对照组为26.5%(30/113),两组间的差异无统计学意义(P＞0.05).研究组患者及移植肝1年存活率分别为95.7%和95.7%,对照组分别为96.5%和94.7%,两组间的差异均无统计学意义(P＞0.05).两组间其它不良反应发生率的差异也无统计学意义.结论 在以他克莫司为基础的免疫抑制治疗方案中,采用巴利昔单抗进行诱导治疗可明显降低肝移植后急性排斥反应发生率,且不增加感染和其它不良反应发生率.     

亲属活体肾移植中父母供肾对移植肾长期存活的影响

目的研究父母供肾对亲属活体肾移植受者移植肾长期存活的影响。方法回顾性分析首都医科大学附属北京友谊医院行父母供肾的亲属活体肾移植并存活5年以上的119例受者临床资料。其中,男性96例,女性23例,平均年龄(28±13)岁。119例供者中,父亲供肾52例,母亲供肾67例,平均年龄(51±13)岁。119例受者均于2010年10月行群体反应性抗体(PRA)检测,并于2014年10月至12月检测肾功能,观察受者抗HLA抗体、供者年龄和性别对移植肾功能的影响。采用χ2检验比较上述指标,P0.05为差异有统计学意义。结果 119例受者中,28例产生抗HLA抗体,其中26例移植肾功能下降,占92.9%;无抗HLA抗体的91例受者中32例移植肾功能下降,占35.2%,差异有统计学意义(χ2=26.26,P0.05)。父亲供肾与母亲供肾移植术后肾功能下降的受者比例分别为38.5%(20/52)和59.7%(40/67),差异有统计学意义(χ2=4.47,P0.05)。119例供者中,81例年龄≥50岁,对应受者中41例肾功能下降(50.6%,41/81);38例供者年龄50岁,对应受者中17例肾功能下降(44.7%,17/38);不同年龄供者供肾移植术后出现肾功能异常的受者比例差异无统计学意义(χ2=0.018,P0.05)。结论父母供肾的亲属活体肾移植中,抗HLA抗体是肾功能下降的重要影响因素,供者性别也可能与术后肾功能下降有关。     

肾移植术后6个月血清肌酐水平对移植肾长期存活的影响

目的探讨肾移植术后半年肾功能对移植肾长期存活的影响。方法回顾性分析自1992年4月至2001年3月在本中心进行首次单纯尸体肾移植病例794例的临床资料。根据术后6个月时间点血清肌酐(Scr)水平,分为肾功能异常组(Scr>133μmol/L)与肾功能正常组(Scr≤133μmol/L)。通过Kaplan-Meier方法分别计算包括急性排斥(AR)、延迟复功(DGF)和不包括AR、DGF时两组患者带功和排除带功死亡时移植肾短期和长期存活率。结果两组在受体移植时年龄、淋巴毒、冷/热缺血时间及免疫抑制剂方案无显著性差异;而男女性别比例、受体体重、随访时间、术后6个月内AR和DGF发生率、术后6个月或12个月环孢素A(CsA)剂量、随访期间及Scr水平等差异有显著性意义。肾功能异常组与正常组相比有较高的AR和DGF的发生率,但不管是否存在AR和DGF,肾功能异常组带功和排除带功死亡时移植肾的长期存活均明显低于肾功能正常组。结论术后6个月Scr水平影响移植肾的长期存活。     

肝移植中应用巴利昔单抗诱导治疗的免疫抑制方案的疗效

目的 探讨肝移植中应用巴利昔单抗诱导治疗的免疫抑制方案的疗效。方法 2007年8月至2009年7月间139例成人肝移植受者接受含巴利昔单抗诱导的免疫抑制方案（诱导组）。以2006年1月至2006年12月间接受常规免疫抑制方案的106肝移植受者为对照组。术后随访12个月,记录两组受者排斥反应、代谢并发症的发生情况,以及患者的存活情况。结果 诱导组术后1个月内急性排斥反应、糖尿病、高血压及感染的发生率分别为7.9％、33.8％、21.6％和22.3％,对照组分别为15.1％、72.6％、40.6％和43.4％,差异有统计学意义(P＜0.05)。术后12个月内,诱导组急性排斥反应、移植后新发糖尿病、高血压以及高脂血症的发生率分别为10.8％、5.0％、4.3％和7.9％,而对照组分别为19.8％、9.4％、8.5％和14.2％,差异有统计学意义(P＜0.05)。诱导组和对照组术后1年的存活率分别为92.1％和88.7％(P＞0.05)。结论 免疫抑制方案中应用巴利昔单抗诱导治疗可以早期撤除皮质激素,并可降低急性排斥反应的发生率及减少使用皮质激素引起的不良反应。     

乙、丙型肝炎病毒感染对肾移植患者长期存活的影响

目的　了解乙型肝炎病毒（ＨＢＶ） 及丙型肝炎病毒（ＨＣＶ） 感染对肾移植患者长期存活的影响。方法　对８０ 例感染ＨＢＶ、ＨＣＶ 者肾移植术后肝病及排斥的发生情况、死亡原因及长期存活率进行分析。结果　移植后慢性肝病发生率为２１ ．２５％ , 死亡率为１８ ．７５ ％ , 显著高于非感染组（１ ．１９ ％ , Ｐ＜ ０．０１） ;ＨＣＶ 组超急性排斥及加速性排斥的发生率（６ ．０６％ ,９ ．０９ ％ ） 显著高于非感染组（０ ．７２ ％ ,２ ．７４ ％ ; Ｐ＜ ０ ．０１ , Ｐ＜ ０ ．０５）。结论　ＨＢＶ及ＨＣＶ感染显著影响肾移植受者的长期存活率; 移植后肝病及感染是其主要死因; 对ＨＢＶ 及ＨＣＶ 感染患者应采取合理的免疫抑制治疗。     

尸体肾移植术后长期存活的体会

我院自1978年3月以来先后为28例终末期肾衰行42例次尸体肾移植,其中2例术后存活超过10年,生活完全自理,能坚持原工作。为探讨延长尸体肾移植病存活时间的有关因素,现总结如下。一、病例报告例1 女,25岁,未婚。既往有慢性肾炎史13年。因面部浮肿、尿少伴恶心呕吐半月转来我院。体检:严重贫血貌,面部轻度浮肿,BP21.3/13.3kPa。胸骨左缘第4肋间可闻及心包磨擦音。EKG示左心室增大,心肌劳损。实验室检查:血:Cr 125mg/L,BUN2500mg/L,CO_2CP 11.76 mmol/L,Hb3.5g/L,RBC1.25×10~(12)/L;尿蛋++。诊断为慢性肾炎及尿毒症入院治疗。3天后血液透析改善     

HLA-DR基因相容对肾移植长期存活的影响

目的 研究人类白细胞Ⅱ类抗原（ＨＬＡ－ＤＲ）基因相容对肾移植长期存活的影响。方法 采用基因分型技术,回顾性分析５１８例首次肾移植ＨＬＡ－ＤＲ基因相容性情况。结果 单个移植中心达到基因水平ＤＲ相配的受者超过１０Ａ％,半数以上可达１个ＤＲ相配。ＨＬＡ－ＤＲ相容的受者急性排斥反应显著减少,早期肾功能恢复顺利,１－５年人存活率提高１０％－２１．７％,肾存活率提高１７％－３７．７％,差异有显著性。     

CsA顺序用药对肾移植长期存活的影响

目的：探讨ＣｓＡ顺序用药对肾移植长期存活的影响。方法：随机选择３２例肾移植患者术后立即应用ＯＫＴ３,并以同期５６例术后立即应用ＣｓＡ的患者为对照。结果：ＯＫＴ３组及ＣｓＡ组急性排斥反应（ＡＲ）发生率分别为３４．４％和６４．３％（Ｐ〈０．０１）,难治性排斥反应发生率ＯＫＴ３组为９．１％,ＣｓＡ组为３０．６％（Ｐ〈０．０５）。术后首次ＡＲ发生时间,ＣｓＡ组为１３．１±１．３ｄ,ＯＫＴ３组为２２．５±３     

阿伦单抗诱导治疗对肾移植受者B细胞再生的影响

近年研究表明B细胞的构成是决定移植物结局的重要因素。初始B细胞和过渡B细胞与移植物的长期存活和操作性耐受密切相关,而记忆B细胞则可能导致移植物失功。阿伦单抗（Campath-1H）系一种人源化抗CD52单抗,能够有效地清除循环血中的T细胞、B细胞、NK细胞和单核细胞,从而越来越多地被应用于肾移植术后的诱导治疗中。已证实在一些自身免疫病如多发性硬化中,阿伦单抗诱导治疗能够改变机体B细胞的构成,从而影响疾病的进展。然而,肾移植术后阿伦单抗诱导治疗对B细胞再生及构成的影响仍不清楚。     

利妥昔单抗用于致敏患者肾移植的诱导治疗一例

体内群体反应性抗体(PRA)为阳性的患者处于致敏状态.这些抗体产生的原因尚未完全明确,输血、妊娠和再次移植等都是危险因素.为了预防移植后的排斥反应,针对致敏患者在移植前会采取一些措施,例如进行供、受者HLA配型以筛选供者;采用血浆置换和免疫吸附等方法降低患者体内预存抗体的滴度;大剂量静脉注射免疫球蛋白(IVIG)以及使用抗CD20单克隆抗体(如利妥昔单抗)等.我们对1例PRA阳性的肾移植受者使用利妥昔单抗进行诱导,效果良好,现报告如下.