预存DSA强阳性患者二次肾移植诊治经验

孙玉洁; 马锡慧; 韩永; 毕丽丽; 张文慧; 肖漓

doi:10.3969/j.issn.1674-7445.2017.03.012

预存DSA强阳性患者二次肾移植诊治经验

doi: 10.3969/j.issn.1674-7445.2017.03.012

100091 北京，解放军第309 医院全军器官移植研究所北京市器官移植与免疫调节重点实验室

基金项目:

国家自然科学基金面上项目 81571555

首都卫生发展科研专项项目 2014-2-5071

中国人民解放军第309医院院内课题面上课题 2016MS-002

中国人民解放军第309医院院内课题面上课题 2014MS-007

详细信息

通讯作者:
肖漓，Email:xiaolilab309@163.com

中图分类号: R617, R392.4
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- 文章访问数: 280
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- PDF下载量: 16
- 被引次数: 0
出版历程
- 收稿日期: 2017-02-23
- 网络出版日期: 2021-01-19
- 刊出日期: 2017-05-15

摘要

摘要: 预存供体特异性抗体（DSA）阳性是肾移植的禁忌证。预存DSA增加排斥反应发生率，使致敏患者存活率降低，直接影响肾移植结果。本文总结1例预存DSA强阳性患者，在二次肾移植前采用血浆置换、利妥昔单抗输注、持续抗胸腺细胞球蛋白滴注，并大剂量静脉注射免疫球蛋白等联合用药方案，抗HLA Ⅱ类抗体滴度显著降低。术后动态监测该受者群体反应性抗体（PRA）和DSA水平，早期发现排斥反应，及时采用地塞米松冲击、抗胸腺细胞球蛋白、大剂量静脉注射免疫球蛋白治疗排斥反应，取得良好效果，患者DSA消失。术后随访5个月，移植肾功能良好。
- 肾移植 /
- 供体特异性抗体（DSA） /
- 群体反应性抗体（PRA） /
- 排斥反应；抗体介导的排斥反应（AMR）

HTML全文

图 1 移植术前后患者Scr水平和尿量的变化

Figure 1. Changes of Scr level and urine volume in the patient before and after transplantation

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图 2 移植术前后患者血清DSA水平的变化

Figure 2. Changes of DSA level in the patient before and after transplantation

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图 3 移植术前后患者血清PRAⅠ、Ⅱ类抗体滴度的变化

Figure 3. Changes of the serum PRA antibody titer of class Ⅰ and Ⅱ in the patient before and after transplantation

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图 4 移植术后第13 d移植肾穿刺活检C4d染色和HE染色（×100）

A图为C4d免疫组织化学染色呈阳性(弥漫性)；B图为HE染色，显示大量间质内弥漫性淋巴细胞浸润、较多的肾小管炎以及少许动脉的内皮炎表现

Figure 4. C4d and HE staining of renal graft biopsy at 13^nd d after transplantation

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