特发性血小板减少性紫癜患者接受肾移植的安全性观察

裴向克; 姜伟; 刘彦斌; 杨其顺; 龙伟; 杨硕滨

doi:10.3969/j.issn.1674-7445.2015.02.007

特发性血小板减少性紫癜患者接受肾移植的安全性观察

doi: 10.3969/j.issn.1674-7445.2015.02.007

066100 河北秦皇岛, 解放军第281医院器官移植科

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通讯作者:
裴向克, Email:pxkmail@126.com

中图分类号: R617
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出版历程
- 收稿日期: 2014-12-23
- 刊出日期: 2015-03-01

Observation on safety of renal transplantation in patients with idiopathic thrombocytopenic purpura

Department of Organ Transplantation, the 281 Hospital of People's Liberation Army, Qinhuangdao 066100, China

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Corresponding author: Pei Xiangke, E-mail:pxkmail@126.com

摘要

摘要: 目的探讨特发性血小板减少性紫癜(ITP)患者接受肾移植的安全性。方法回顾性分析两例ITP肾移植患者的临床资料并结合相关文献进行复习。结果两例患者肾移植术前血小板计数分别为41×10⁹/L及34×10⁹/L, 凝血功能正常, 临床无活动性出血表现, 均成功进行肾移植手术, 术中、术后无明显出血。1例患者术后接受氢化可的松冲击治疗3 d并服用以环孢素为基础免疫抑制剂, 术后7 d血小板计数恢复至正常范围并维持稳定。另1例患者术后接受甲泼尼龙冲击治疗3 d并服用以他克莫司为基础的免疫抑制剂, 术后应用多种提升血小板药物并输注血小板治疗, 血小板波动在10×10⁹/L~30×10⁹/L。两例患者移植肾功能均恢复良好。结论 ITP患者的肾移植手术出血的风险性主要与患者在术前有否活动性出血有关, 术前无活动性出血的尿毒症患者行肾移植是相对安全的。
- 肾移植 /
- 特发性血小板减少性紫癜 /
- 环孢素 /
- 他克莫司 /
- 肾上腺皮质激素
Abstract: Objective To investigate the safety of renal transplantation in patients with idiopathic thrombocytopenic purpura (ITP). Methods Clinical data of two ITP patients undergoing renal transplantation were retrospectively analyzed and pertinent literatures were reviewed. Results Prior to renal transplantation, the platelet count of these two patients was 41×10⁹/L and 34×10⁹/L, respectively. The coagulation function was normal and no active bleeding was observed. They underwent renal transplantation successfully without obvious bleeding intra-or post-operatively. The platelet count of one patient who received hydrocortisone impulse therapy for three days and maintenance treatment with immunosuppressant based on ciclosporin recovered to normal range and kept stable at 7 days after renal transplantation. Though receiving platelet-promoting drugs and platelet infusion, the platelet count of the other patient treated with methylprednisolone impulse therapy for 3 days and maintenance therapy with immunosuppressant based on tacrolimus did not recover to normal range but fluctuated between 10×10⁹/L and 30×10⁹/L after renal transplantation. Renal function was well maintained in both recipients. Conclusions The risk of renal transplantation related bleeding in ITP patients is correlated with whether the preoperative active bleeding or not. Renal transplantation is relatively safe for uremia patients without active bleeding pre-operation.
- Renal transplantation /
- Idiopathic thrombocytopenic purpura /
- Ciclosporin /
- Tacrolimus /
- Adrenocortical hormone

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参考文献(18)

[1]	Provan D, Stasi R, Newland AC, et al. International consensus report on the investigation and management of primary immune thrombocytopenia[J]. Blood, 2010, 115(2):168-186. doi: 10.1182/blood-2009-06-225565
[2]	侯明.成人特发性血小板减少性紫癜诊断治疗专家共识[J].中华血液学杂志, 2009, 30(9):647-648. http://d.wanfangdata.com.cn/Periodical/zhxyx200909020 Hou M. Expert consensus on the diagnosis and treatment of adult idiopathic thrombocytopenic purpura[J]. Chin J Hematol, 2009, 30(9):647-648. http://d.wanfangdata.com.cn/Periodical/zhxyx200909020
[3]	Gómez-Almaguer D, Tarín-Arzaga L, Moreno-Jaime B, et al. High response rate to low-dose rituximab plus high-dose dexamethasone as frontline therapy in adult patients with primary immune thrombocytopenia[J]. Eur J Haematol, 2013, 90(6):494-500. doi: 10.1111/ejh.2013.90.issue-6
[4]	Colović M, Suvajdzic N, Colović N, et al. Mycophenolate mophetil therapy for chronic immune thrombocytopenic purpura resistant to steroids, immunosuppressants, and/or splenectomy in adults[J]. Platelets, 2011, 22(2):153-156. doi: 10.3109/09537104.2010.520372
[5]	Li J, Wang Z, Dai L, et al. Effects of rapamycin combined with low dose prednisone in patients with chronic immune thrombocytopenia[J]. Clin Dev Immunol, 2013:548085. https://www.hindawi.com/journals/jir/2013/548085/
[6]	计成阜, 何广胜, 周海侠, 等.重组人血小板生成素联合环孢素A治疗难治性血小板减少症16例[J].实用医学杂志, 2013, 29(22):3789-3790. http://www.cnki.com.cn/Article/CJFDTOTAL-SYYZ201322075.htm Ji CF, He GS, Zhou HX, et al. Recombinant human platelet thrombopoietin combined with ciclosporrin on treatment of intractable thrombocytopenia in 16 cases[J]. J Prac Med, 2013, 29(22):3789-3790. http://www.cnki.com.cn/Article/CJFDTOTAL-SYYZ201322075.htm
[7]	Emilia G, Morsetli M, Luppi M, et al. Long-term salvage therapy with cyclosporine A in refractory idiopathic thrombocytopenic purpura[J]. Blood, 2002, 99(4):1482-1485. doi: 10.1182/blood.V99.4.1482
[8]	Cui ZG, Liu XG, Qin P, et al. Recombinant human thrombopoietin in combination with cyclosporin A as a novel therapy in corticosteroid-resistant primary immune thrombocytopenia[J].Chin Med J, 2013, 126(21):4145-4148. http://www.researchgate.net/publication/258526016_Recombinant_human_thrombopoietin_in_combination_with_cyclosporin_A_as_a_novel_therapy_in_corticosteroid-resistant_primary_immune_thrombocytopenia
[9]	Gergis U, Ibrahim M, Al-Kazaz M, et al. Successful treatment with tacrolimus of a patient with severe idiopathic thrombocytopenic purpura after allogeneic bone marrow transplantation[J]. J Clin Oncol, 2012, 30(26):e241-e242. doi: 10.1200/JCO.2011.40.0499
[10]	Wakana K, Yasugi T, Nako Y, et al. Successful surgical treatment and chemotherapy for ovarian cancer in a patient with idiopathic thrombocytopenic purpura[J]. Int J Clin Oncol, 2011, 16(4):447-449. doi: 10.1007/s10147-010-0149-3
[11]	Nakajima T, Iyoda A, Iizasa T, et al. Surgical treatment of a superior sulcus tumor in a patient with idiopathic thrombocytopenic purpura:report of a case[J]. Surg Today, 2005, 35(12):1078-1080. doi: 10.1007/s00595-005-3069-5
[12]	Kubota Y, Horie K, Nagai S, et al. Laparoscopic left partial nephrectomy for renal cell carcinoma associated with ITP with platelet count of 10, 000/μL[J]. Hinyokika Kiyo(日文), 2013, 59(12):785-789.
[13]	Kanodia KV, Vanikar AV, Shah PR, et al. Renal transplantation in idiopathic thrombocytopenic purpura[J]. Saudi J Kidney Dis Transpl, 2013, 24(4):793-794. doi: 10.4103/1319-2442.113890
[14]	Einollahi B. Renal transplantation and idiopathic thrombocytopenic purpura:two case reports[J]. Transplant Proc, 2009, 41(7):2923. doi: 10.1016/j.transproceed.2009.07.010
[15]	Hwang EM, Woo HY, Choi BS, et al. Renal transplantation in a patient with idiopathic thrombocytopenic purpura[J]. Korean J Intern Med, 2005, 20(1):92-95. doi: 10.3904/kjim.2005.20.1.92
[16]	Kojouri K, Vesely SK, Terrell DR, et al. Splenectomy for adult patients with idiopathic thrombocytopenic purpura:a systematic review to assess long-term platelet count responses, prediction of response, and surgical complications[J]. Blood, 2004, 104(9):2623-2634. doi: 10.1182/blood-2004-03-1168
[17]	Ferndale L, Naidoo M, Bhaila SH, et al. Laparoscopic splenectomy for immune thrombocytopenic purpura[J]. S Afr J Surg, 2013, 51(2):54-56. doi: 10.7196/sajs.1325
[18]	Qu Y, Xu J, Jiao C, et al. Long-term outcomes of laparoscopic splenectomy versus open splenectomy for idiopathic thrombocytopenic purpura[J]. Int Surg, 2014, 99(3):286-290. doi: 10.9738/INTSURG-D-13-00175.1