血浆置换在ABO血型不相容的亲属活体肾移植中应用效果评价

目的观察血浆置换在ABO血型不相容亲属活体肾移植中清除血型抗体的临床应用效果。方法回顾分析2017年7月~2019年1月本院54例行ABO血型不相容肾移植患者的临床特征及行血浆置换治疗后血型抗体效价变化情况,分析血浆置换治疗过程中不良反应发生情况。结果52/54例患者血型抗体(包括IgG和IgM)效价成功降至术前目标滴度,顺利进行肾移植手术;1例患者术后出现血型抗体反弹,移植肾失功;2例患者血型抗体效价未能降至目标水平,放弃肾移植手术,继续行肾脏替代治疗。血浆置换降低ABO血型不相容肾移植受者血型抗体的总有效率为94%。128次血浆置换过程中共发生了49次轻度不良反应。结论血浆置换是降低ABO非同型肾移植受者血型抗体(包括IgG和IgM)的有效方法,可与其他免疫抑制剂联合使用,缩短移植前血型抗体高滴度受者术前预处理时间。

The Clinical Effect of Plasma Exchange in ABO Incompatible Relatives in vivo Kidney Transplantation

Objective To observe the clinical effect of plasma exchange in removing blood group antibody in ABO incompatible relatives kidney transplantation.Methods The clinical characteristics of 54 cases of ABO non-identical relatives kidney transplantation in our hospital from July 2017 to January 2019 were analyzed retrospectively,and the changes of blood group antibody titer after plasma exchange treatment were analyzed.Results The titers of blood group antibodies(including IgG and IgM)were successfully reduced to the preoperative target titer in 2/54 patients,and renal transplantation was successfully carried out in 1/52 patients;One patient had the rebound titer of blood group antibody after operation,and the transplanted kidney failed.Two patients did not reduce the titer of blood group antibody to the target level.They gave up the kidney transplantation and continued the hemodialysis replacement treatment.There were 49 mild adverse events in 128 plasma exchange procedures.Conclusion Plasma exchange is an effective method to reduce the blood group antibody(including IgG and IgM)titer of recipients,which can be used in combination with other immunosuppressants to shorten the pre-operation time of patients with high blood group antibody titer.