第3次肾移植术治疗合并HLA抗体强阳性患者1例

肾移植受者体内存在的人类白细胞抗原(human leukocyte antigen，HLA)抗体阳性既影响手术又易发生排斥 反应，还能影响移植肾的长期存活。行第3次肾移植，双侧髂窝及髂血管均遭到破坏。由于粘连重、瘢痕形成多、容 易损伤血管及肠管等，所以无论是手术血管的选取还是分离均非常困难。中南大学湘雅三医院收治1例HLA抗体强阳 性，2次切除移植肾行第3次肾移植患者，术中成功处理移植空间少及血管疤痕粘连等问题，避开敏感位点，运用利 妥昔单抗、兔抗人胸腺细胞免疫球蛋白及甲泼尼龙处理抗体，术后利用免疫功能检测制订个体化治疗方案等。术后 患者肌酐、尿量趋向平稳，随访16个月移植肾功能良好。

A case of nephrectomy with strong positive HLA antibody undergoing the third renal transplantation

The positive human leukocyte antigen (HLA) antibody present in kidney transplant recipients aff ects both surgery and rejection, and also aff ects the long-term survival of the transplanted kidney. During the third kidney transplant, bilateral axillary fossa and iliac vessel were destroyed. It was very diffi cult for selection or separation of surgical vessels because the adhesions and scar formation was easy to damage blood vessels and intestinal tubes. A case with strong positive HLA antibody undergoing the third kidney transplant in our hospital was successfully solved the problems, such as less transplant space and vascular scar adhesion. Rituximab, rabbit anti-human thymocyte immunoglobulin, and methylprednisolone treated-antibodies were used in the operation. The immune function test was used to develop individualized treatment after the operation. Thepostoperative creatinine and urine volume tended to be stable, and the 16-month follow-up renal function was good.