蛋白A免疫吸附治疗高致敏肾移植受者1例报告并文献复习

目的肾脏移植的致敏性是目前临床面临的一大难题,高致敏受者接受移植的机会大大减少,我们对1例高致敏受者肾移植围手术期采用蛋白A免疫吸附疗法配合免疫抑制治疗,观察其临床效果,结合文献评估疗效.方法受者采用蛋白A免疫吸附成功进行肾移植病例,同时回顾通过国内外文献检索得到的蛋白A免疫吸附治疗肾移植高致敏受者的病例.结果结合我们目前的病例,分析已被报道的66例(国内30例,国外36例)蛋白A免疫吸附治疗肾移植高致敏受者的病例,发现大部分患者采用了蛋白A免疫吸附可以明显降低IgG、IgM、IgA等,PRA从术前30%～100%降低到术后30%以下,65例成功进行了肾移植.结论 Protein A免疫吸附可以清除体内免疫球蛋白疗效明显,结合免疫抑制治疗使肾移植高致敏受者成功接受肾移植,提高移植肾远期存活率.

Peri-operative protein A immunoadsorption in sensitized renal transplant recipients: a case report and literature review

Objective Recipients with high levels of panel reactive antibodies(PRA) are at increased risk of early immunologic graft loss.We study the protein A immunoadsorption(IA) in one patient and review literatures to investigate its effect and safety.Methods A re-transplanted recipient was treated with protein A IA before transplantation and during the early post-transplantation period.Literatures were reviewed to evaluate the effect of this therapy.Results Sixty-six high levels of PRA (range 30%-100%) recipients,after treated with IA(protein A) immediately before transplantation and during the early post-transplantation period,IgG,IgM,IgA were decreased and PRA was decreased to postoperative 30%.Sixty-five patients received a successful transplantation.Conclusion Protein A IA and anti-lymphocyte antibody therapy might be an effective and safe therapeutic strategy for the highly sensitized patients awaiting renal transplantation.The treatment can prevent early graft failure and increase the graft survival in the recipients.