肾移植术后应用抗CD3单克隆抗体在预防急性排斥反应的体会

目的观察抗CD3单克隆抗体在预防肾移植术后急性排斥反应的作用。方法164例肾移植患者分为两组,42例移植术后应用抗CD3单克隆抗体(5mgd)为治疗组;其它122例为对照组。观察移植术后人肾存活率、急性排斥反应及CMV感染的发生率。结果治疗组1年、2年及3年人存活率与对照组无显著差异,而治疗组移植肾存活率明显高于对照组(P<005)。治疗组急性排斥反应发生率(119%)比对照组(287%)低(P<005),且首次急性排斥反应发生时间明显延长,对MP冲击治疗效果好。治疗组CMV感染的发生率(333%)高于对照组(P<005)。结论肾移植术后预防性使用抗CD3单克隆抗体对提高移植肾存活率,降低急性排斥反应发生率有较好的作用;用药期间应注意预防及治疗CMV感染。     

Therapeutic plasma exchange performed in parallel with extra corporeal membrane oxygenation for antibody mediated rejection after heart transplantation

We report on the feasibility, safety, and efficacy of performing therapeutic plasmapheresis (TPE) in parallel with extracorporeal membrane oxygenation (ECMO) to alleviate antibody mediated rejection (AMR) after heart transplantation. Two pediatric and one adult patient presented with severe congestive heart failure and respiratory distress after heart transplantation and required ECMO support. TPE was initiated to treat AMR while patients remained on ECMO. Each patient received three to five procedures either every day or every other day. One equivalent total plasma volume (TPV) was processed for each procedure (patient TPV + ECMO extracorporeal TPV). A total of 13 TPE procedures were performed with 12 procedures completed without complications or adverse events; one procedure was terminated before completion because of cardiac arrhythmia. Anti-HLA antibody titers decreased after TPE in all three patients. Ventricular function improved and ECMO was discontinued in 2 of 3 patients. Performing large volume TPE with a processed volume up to 2.5 times the patient's TPV is well tolerated in both pediatric (< or = 10 kg) and adult patients. TPE in parallel with ECMO is feasible, safe, and may be measurably effective at reducing anti-HLA antibodies and should be considered as part of the treatment for patients with early AMR after heart transplantation.