静脉注射用免疫球蛋白对降低高致敏肾移植受者群体反应性抗体的作用

目的 观察并分析静脉注射用免疫球蛋白(IVIG)在高致敏受者肾移植中的应用效果.方法 回顾性分析18例群体反应性抗体(PRA)阳性的高致敏肾移植受者的临床资料,所有受者均应用IVIG进行治疗.观察治疗后受者的抗体水平、术后排斥反应发生率,并结合文献资料对IVIG的应用进行综合评价.结果 应用IVIG前,18例受者中有2例PRA水平为100%,4例＞70%、8例＞50%、4例＞30%,应用IVIG后所有受者PRA水平明显下降,其中2例受者转为全阴性,15例受者抗HLA-Ⅰ类和抗HLA-Ⅱ类抗体＜30%,两者比较,差异有统计学意义(P＜0.01),应用IVIG后肾移植效果良好,受者术后急性排斥反应发生率为38.5%,未出现移植肾的丢失.结论 应用IVIG能有效降低高致敏肾移植受者的PRA水平,联合应用生物抗体和免疫抑制剂可以使更多高致敏受者获得肾移植机会,并且术后应用IVIG具有抗排斥反应作用.

Intravenous immunoglobulin in adjuvantly treatment of high sensitized patients of kidney transplantation

Objective To investigate the effect of high dose immunoglobulin in highly sensitized patients awaiting kidney transplantation Methods There was 18 highly sensitized patients awaiting renal transplantation having higher level panel reactive antibody(PRA) after addition of high dose im munoglobulin. The therapeutic response and the affecting factors were retrospective analysis. Results After 4 times IVIG therapy, the 14 patients had a lower PRA while the remaining 4 patients were positive and the clinical result of kidney transplant was satisfied. The acute rejection rate was 38.5% and renal function recovered rapidly. Conclusion High dose immunoglobulin in highly sensitized patients awaiting kidney transplantation was a novel approach to improve transplant rates and outcomes in highly HLA-sensitized patients.