肾移植后急性排异反应12例

背景：同种异体肾移植后发生的急性排斥反应是移植肾功能减退和最终移植肾丧失的最主要原因之一。有效预防和早期发现与治疗急性排异反应是关系到肾脏移植患者能否长期存活的重要问题。目的：总结肾移植后1个月内急性排异反应患者治疗过程中免疫抑制剂的应用体会。方法：选择首次肾移植患者12例,移植后采用霉酚酸酯＋环孢素A＋甲泼尼龙三联预防排异反应。当肾移植后3～30d内出现尿量减少、移植肾区胀痛不适、血肌酐升高、尿蛋白增加等不同临床表现,确诊为肾移植后急性排斥反应时,先选用甲强龙500mg/d静脉滴注,连续3d。然后改甲泼尼龙24mg口服1次/d,每5～7d递减4mg,至8mg/d维持。结果与结论：12例患者成功逆转,其中6例甲强龙冲击疗法成功;不能逆转者选用抗胸腺细胞球蛋白或CD3治疗。4例经抗胸腺细胞球蛋白治疗患者中1例8h内尿量迅速增加,2例24h内尿量迅速增加,1例72h后尿量迅速增加;1例选用CD3治疗48h内尿量迅速增加;1例将环孢素转换为他克莫司治疗,同时服用霉酚酸酯胶囊和甲泼尼龙片。经以上治疗12例患者肾功能逐渐恢复。提示肾移植后早期发现、早期诊断、及时治疗是急性排异反应成功逆转的关键。

Acute rejection following kidney transplantation in 12 cases

BACKGROUND：After the allogeneic kidney transplant operation, acute rejection is one of the most important reasons of transplant kidney hypofunction and eventually defunctionalization. So effective prevention, early diagnosis and acute rejection therapy are important things which relate closely to how long the patient can live. OBJECTIVE：To summarize the experience of application of immunosuppressive on patients with acute rejection in one month after kidney transplantation. METHODS：A total of 12 kidney transplantation patients were selected, who are all the first time to do the transplant. After the kidney transplantation, using mycophenolate mofetil capsules, cyclosporine A and methylprednisolone as triple regimen to prevent rejection. During 3 to 30 days after operations, the 12 patients had different clinical manifestation, such as hypourocrinia, kidney transplanted area swollen, serum creatinine increase, urine protein increase, instituted as acute rejection after renal transplantation. First, the patients were treated with methylprednisolone pulse therapy：5mg/d （d1-3）, intravenous drip. Then, taking it orally instead, 24 mg/d, decreasing by 4 mg every 5-7 d, until 8 mg/d. RESULTS AND CONCLUSION：12 cases reversed successfully, including 6 cases which reversed by methylprednisolone. Those unable to reverse were treated with Antithymocyte Globulin （ATG） or CD3. In 1 of 4 cases with ATG, urinary output increased rapidly within 8 hours, 2 cases within 24 hours and 1 case within 72 hours. One case with CD3, patient’s urinary output rose quickly within 48 hours. One case used tacrolimus instead of cyclosporine A, at the same time took mycophenolate mofetil capsules and methylprednisolone. After the above treatments, kidney function in all 12 cases recovered gradually. The results suggested that, for patients with acute rejection after kidney transplantation, early detection, diagnosis and timely therapy is the key to reversal successfully.