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双重膜滤过式血浆置换清除肾移植受者供体特异性抗体的临床观察

廖琪 蒋秋艳 熊艳 王凤英 晏强 邹贵勉 眭维国

廖琪, 蒋秋艳, 熊艳, 等. 双重膜滤过式血浆置换清除肾移植受者供体特异性抗体的临床观察[J]. 器官移植, 2017, 8(6): 455-459. doi: 10.3969/j.issn.1674-7445.2017.06.009
引用本文: 廖琪, 蒋秋艳, 熊艳, 等. 双重膜滤过式血浆置换清除肾移植受者供体特异性抗体的临床观察[J]. 器官移植, 2017, 8(6): 455-459. doi: 10.3969/j.issn.1674-7445.2017.06.009
Liao Qi, Jiang Qiuyan, Xiong Yan, et al. Clinical observation on the removal of donor specific antibody by double filtration plasmapheresis in renal transplant recipients[J]. ORGAN TRANSPLANTATION, 2017, 8(6): 455-459. doi: 10.3969/j.issn.1674-7445.2017.06.009
Citation: Liao Qi, Jiang Qiuyan, Xiong Yan, et al. Clinical observation on the removal of donor specific antibody by double filtration plasmapheresis in renal transplant recipients[J]. ORGAN TRANSPLANTATION, 2017, 8(6): 455-459. doi: 10.3969/j.issn.1674-7445.2017.06.009

双重膜滤过式血浆置换清除肾移植受者供体特异性抗体的临床观察

doi: 10.3969/j.issn.1674-7445.2017.06.009
基金项目: 

广西卫生厅计划课题 Z2013789

详细信息
    通讯作者:

    邹贵勉, Email: zougm2004@126.com

  • 中图分类号: R617, R392.4

Clinical observation on the removal of donor specific antibody by double filtration plasmapheresis in renal transplant recipients

More Information
  • 摘要:   目的  探讨双重膜滤过式血浆置换(DFPP)对高致敏肾移植受者的供体特异性抗体(DSA)的清除效果。  方法  4例肾移植高致敏受者共进行了7例次DFPP治疗,采用Luminex技术监测DSA的变化,观察治疗效果、急性排斥反应发生情况及其不良反应。  结果  治疗后DSA的MFI [1 036(0~4 113)]较治疗前[6 446(2 999~12 905)]明显下降(Z=-2.503,P=0.012)。4例高致敏肾移植受者均未发生超急性排斥反应,仅有1例发生急性排斥反应且通过术后DFPP治疗及调整免疫抑制剂得到逆转。受者随访至今移植肾功能良好,未发生排斥反应。DFPP治疗引起白蛋白水平下降。  结论  DFPP可以有效清除受者体内的DSA,可以安全、有效地预防高致敏人群肾移植术后急性排斥反应。

     

  • 表  1  4例受者的DSA特异性分析及其对应供者的HLA基因分型

    Table  1.   DSA specificity analysis of 4 recipients and HLA genotype of corresponding donors

    例序 受者DSA 供者HLA基因分型
    1 A24(9),DQ5 A[2, 24(9)],B(60, 60),DR(16, 16),DQ[5(1), 5(1)]
    2 DR16,DRw51 A(1101, 1101),B(13, 60),DR(16, 16),DRw(51, 51),DQ[(5(1), 5(1)]
    3 A2,DR15(2),DQ6(1),DQ9(3),DR51,DR53 A(1, 2),B(46, 52),DR(9, 15),DRw(53, 51)
    4 A2,DR15(2),DRw51,DQ6(1),DQ7(3) A(1101, 2),B(75, 58),DR(15, 12),DRw(51, 52),DQ[7(3), 6(1)]
    下载: 导出CSV

    表  2  4例受者7例次DFPP治疗前后免疫球蛋白和补体的变化

    Table  2.   Changes of immunoglobulin and complement in 4 recipients before and after DFPP treatment

    [M(Q), g/L]
    指标 治疗前(n=7) 治疗后(n=7) Z P
    IgG 14.71(9.63~18.62) 3.32(2.87~4.86) -3.981 0.001
    IgA 2.88(1.48~3.89) 0.50(0.21~1.63) -2.958 0.003
    IgM 0.99(0.75~2.50) 0.22(0.17~1.16) -2.113 0.035
    C3 1.03(0.75~1.32) 0.37(0.32~0.77) -2.958 0.003
    C4 0.32(0.14~0.52) 0.07(0.01~0.12) -2.551 0.011
    下载: 导出CSV
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出版历程
  • 收稿日期:  2017-08-08
  • 网络出版日期:  2021-01-19
  • 刊出日期:  2017-11-15

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