IA在预防肾移植后超急性排斥反应中的应用观察

目的观察葡萄球菌蛋白A免疫吸附(IA)治疗在预防肾移植术后超急性排斥反应(HAR)的疗效,探讨IA治疗方案。方法16例群体反应性抗体(PRA)50%~98%的肾移植患者在术前行IA治疗151人次,每次再生血浆3000~4500mL,强化IA时,每次再生血浆7500mL,检测每次IA治疗前后血清免疫球蛋白(Ig)、补体(C3、C4)及PRA,追踪患者肾移植术的转归。结果16例患者经IA治疗5~12次后,PRA均降至10%以下(其中3例阴性),Ig、C3、C4均明显下降(P<0.05),肾移植术后均未发生HAR,观察6~12个月经过良好。结论IA能迅速清除患者体内的抗体,降低PRA水平,预防HAR的发生。

clinical application of immunoadsorption for prevention of hyper acute rejection after renal transplantation

To observe the effect of immunoadsorption(IA) of staphylococci protein A for the prevention of hyper acute rejection (HAR) after renal transplantation, the suitable regimen, dosage and opportunity of IA were explored. In 16 patients with population reaction antibody (PRA) arranged 50%~98%, IA was carried out 151 times before and after renal transplantation, with actified plasma 3 000~4 500 mL per time, and when intensified, 7 500 mL per time. Immunoglobin(Ig), complement (C3, C4) and PRA were assayed before and after IA therapy. The patients were followed up for systemic conditions and HAR development. After IA treatment of 5~12 times in the 16 patients, PRA was decreased to less than 10%, and in three patients, it was negative. Ig, C3, C4 fallen were more obvious after operation than before (P <0.05). No HAR developed after renal transplantation, and the systemic conditions were good during the follow up period of 6~12 months. [Conclusion] IA therapy can rapidly clear the antibodies in the body, decrease PRA level and prevent HAR.