静脉滴注免疫球蛋白对肾移植患者群体反应抗体的影响(英文)

背景:很多方法可降低群体反应抗体致敏患者的群体反应抗体水平,其中血浆置换或免疫吸附法脱敏法是比较常用的,但这些方法副作用较多。目的:拟观察肾移植前静脉滴注免疫球蛋白对肾移植患者血清群体反应抗体的影响。设计、时间及地点:以2003-01/2006-11重庆医科大学附属第一医院肾移植中心的57例等待肾移植的群体反应抗体致敏患者为对象的前后对照,病例分析。对象:群体反应抗体致敏患者57例,年龄21～65岁,群体反应抗体值平均(46.7±29.5)%。方法:所有患者在接受肾移植前以5g/d剂量静脉滴注免疫球蛋白,2周为1个疗程。2个疗程之间间隔1周。在给予静脉滴注免疫球蛋白前和疗程结束立即应用酶联免疫吸附反应方法各检测1次血清群体反应抗体水平。主要观察指标:血清群体反应抗体水平。结果:应用免疫球蛋白后群体反应抗体降为非致敏84%(48/57),完全未降5%(3/57),部分下降11%(6/57)。用药后群体反应抗体下降0～61%,平均(38.4±16.3)%。57例患者肾脏移植前淋巴细胞毒试验<10%,均未出现超急性排斥反应。结论:静脉滴注免疫球蛋白预治疗是理想的降低肾移植致敏性的方法,且副作用小。

Impact of intravenous immunoglobulin to penal reactive antibody levels in highly sensitized adult patients waiting for renal transplantation

BACKGROUND: Many methods can reduce panel reactive antibody (PRA) levels in highly sensitized adult patients waiting for renal transplantation. Desensitisation with plasmapheresis or immunoabsorption is commonly used. Howevel the adverse effects limit their applications. OBJECTIVE: To investigate the effect of pretreatment of intravenous immunoglobulin (IVIG) on PRA levels in highly sensitized adult patients waiting for renal transplantation. DESIGN, TIME AND SETTING: Case analysis, self-contrast of 57 patients waiting for renal transplantation from Ren Transplantation Center. First Affiliated Hospital of Chongqing Medical University between January 2003 and Novembem 2006. PARTICIPANTS: Fifty-seven adult patients, who were highly sensitized to the human leucocyte antigen (HLA), agcd 21 to 65 years. were selected. The average baselines of PRA levels of patients were(46.7±29.5)%. METHODS: All patients received IVIG pretreatments at a dose of 5 g/d for 2 weeks. as one course of treatment. A weel later. some of them received additional 2 weeks iniection of IVIG. The PRA levels of patients were measured before and just after the IVIG treatments. MAIN OUTCOME MEASURES: PRA levels. RESULTS: It was significantly decreased below the non-sensitive level(＜10%)in 48 candidates(84.2%),and partially decreased in 6 ones(10.6%),however, was not changed in 3 ones(5.2%).The total effective rate was 94.8%.Thereafter.each candidate received a cadaveric renal graft. The preoperative complement-dependent cytotoxicity of each candidate was blow 10%. Furthermore. no hyperacute rejection was observed in all 57 recipients. Only two recipients experienced acute reiection, however, that was successfully conversed by methylprednisolone and FK506 treatments. CONCLUSION: Pretreatment of IVIG is a promising and effective option for lower allosensitization and can improve transplantation in highly sensitized candidates with end-stage renal diseases.