淋巴细胞去除加血浆置换对高敏患者肾移植后排斥反应的影响

目的探讨淋巴细胞去除+血浆置换(PE)减少高敏患者肾移植后排斥反应的疗效。方法32例肾移植前群体反应性抗体(PRA)阳性≥30%(30%~90%)患者,先作血淋巴细胞去除加PE治疗(LAPE)1~3次后,当PRA<30%后才作尸体肾移植作治疗组。32例PRA阳性,强度≥30%(30%~70%)患者进行尸体肾移植作对照组。比较两组患者术后6个月内排斥反应情况。结果对照组术后排斥反应率为68.8%(22/32)。治疗组移植后排斥反应发生率为9.4%(3/32),P<0.001。结论淋巴细胞去除加PE治疗能明显减少有预先形成抗体的高敏患者的肾移植后排斥反应,疗效满意。

Influence of lymphopheresis and plasma exchange therapy on renal transplant rejection in highly sensitive

Objective To investigate the effect of lymphopheresis and plasma exchange(PE) therapy on reducing renal transplantation rejection in highly sensitive recipients. Methods Rejections within 6 months after renal transplantation were compared between the groups of patients.One of which was composed of 32 recipients whose panel reactive antibody levels before the transplantation were from 30% to 70%,and another was composed of 32 recipients whose panel reactive antibody levels were from 30% to 90%.The later group of patients received lymphopheresis and PE therapy before transplantation and had not undergone renal transplantation operation until their panel reactive antibody levels were below 30% or negative. Results After transplantation,the rejection incidence was 68.8%(22/32) for those 32 recipients without lymphopheresis and plasma exchange therapy and 9.4%(3/32) for the 32 recipients receiving lymphopheresis and PE therapy respectively.The difference was very significant P<0.001. Conclusion For the highly sensitive recipients who have the Pre-transplant antibodies,lymphopheresis and PE therapy can significantly reduce the post-transplant rejection incidence.