利妥昔单抗在肾移植后抗体介导的急性排斥反应中的应用五例

目的 观察肾移植受者发生抗体介导的急性排斥反应(AMR)时应用利妥昔单抗的安全性和有效性。方法 回顾分析2010年12月至2011年6月间5例发生AMR的肾移植受者的资料，患者采用利妥昔单抗(500 mg)进行治疗。记录患者的年龄、性别、发病时间、免疫诱导方案、免疫维持方案、移植肾功能、群体反应性抗体(PRA)水平、感染及其他并发症发生情况等，评价利妥昔单抗治疗的有效性和安全性。结果 5例治疗后移植肾功能均有不同程度的恢复，其中4例血肌酐恢复正常，1例血肌酐维持在300μmol/L左右。病理检查结果表明，治疗后移植肾C4d沉积明显减轻。随访6～12个月，1例发生巨细胞病毒血症，1例发生泌尿系统感染，无受者发生严重感染，人/肾存活率100％。结论 利妥昔单抗治疗肾移植术后AMR的效果和安全性均较好。

Application of Rituxnab in antibody-mediated rejection among renal transplantation recipients

Objective To observe the indication, safety and efficacy of a new immunosuppressant Rituximab in kidney transplantation. Methods Five patients, who were diagnosed as antibody mediated rejection (AMR) from December 2010 to June 2011, were treated with single dose of Rituximab (500 mg) and followed up for 6 months. The clinical data, such as age, gender, onset of illness, induction therapy, maintaining therapy, allograft function, change of PRA, opportunistic infection and other complications were collected and retrospectively analyzed to evaluate the safety and efficacy of Rituximab used in AMR patients. Results After Rituximab therapy, all the patients had improved renal function measured by sera creatinine level: 4 cases retumed to normal, and 1 keep stable. Series of allograft biopsy demonstrated obviously reduced C4d deposition in nephridial tissue after treatment. One patient developed CMV viremia, another had urinary infection, but no one had lifethreatening infection during the follow-up period. The survival rate of human and allograft was both 100 ％. Conclusion Rituximab has a good efficacy and safety in treatment of AMR after renal transplantation.