ABO血型不相容亲属肾移植12例并文献复习

doi:10.6040/j.issn.1671-7554.0.2022.1341

摘要/Abstract

摘要： 目的研究ABO血型不相容的亲属捐献肾移植围术期处理措施,及针对并发症的预防与治疗。方法收集2020年7月—2021年4月肾移植病区完成的12例ABO血型不相容肾移植供受者的相关资料。其中,A型捐给O、B型分别为2例、1例,B 型捐给O、A型分别为6例、1 例,AB 型捐给 B 型 2 例。根据首次化验的血型抗体滴度的数值,采用利妥昔单抗(美罗华)、血浆置换和免疫抑制剂相结合的不同脱敏治疗方案。并监测受者围术期血型抗体滴度、肾功能、淋巴细胞计数等变化趋势。结果 12例受者经简化的脱敏方案处理后,血型抗体滴度水平均达到术前目标。术后半个月内,4例受者血型抗体效价升高,需要血浆处理干预。术后发生肌酐正常后反弹、重度贫血、反复腹泻、心律失常及心力衰竭、尿BK病毒阳性等并发症各1例,治疗后肾功能恢复良好。结论采用精简预处理方案可达到理想的血型抗体滴度,个体化精准防治并发症,能实现满意的近期疗效。

关键词: 血型不相容, 肾移植, 体液排斥反应, 脱敏治疗, 排斥反应, 血浆置换

Abstract: Objective To explore the perioperative management, prevention and treatment of complications of ABO incompatible relatives who underwent kidney transplantation. Methods Data of 12 pairs of donors and recipients of ABO incompatible renal transplantation completed during July 2020 and April 2021 were collected, including 2 type A donors to type O recipients and 1 type A donor to type B recipients; 6 type B donors to type O recipients and 1 type B donor to type A recipient; 2 type AB donors to type B recipients. According to the titer of blood group antibody in the first test, different desensitization treatment schemes of rituximab(rituximab), plasma exchange and immunosuppressant were adopted. The changes of perioperative blood group antibody titer, renal function and lymphocyte count were monitored. Results The blood group antibody titers of 12 recipients treated with simplified desensitization schemes reached the preoperative target. The titer of blood group antibody increased in 4 recipients within half a month after transplantation, and plasma treatment intervention was conducted. Postoperative complications such as rebound after normal creatinine, severe anemia, recurrent diarrhea, arrhythmia, heart failure and positive urinary BK virus occurred in 1 case, respectively. After treatment, the renal function recovered well. Conclusion The simplified pretreatment schemes can achieve ideal blood group antibody titer, individualized and accurate prevention and treatment of complications, and achieve satisfactory short-term curative effects.

Key words: Blood group incompatibility, Renal transplantation, Humoral rejection, Desensitization treatment, Rejection, Plasma exchange

中图分类号:

R617

丁汉东,钟金彪,王琴,廖贵益. ABO血型不相容亲属肾移植12例并文献复习[J]. 山东大学学报 (医学版), 2023, 61(8): 67-73.

DING Handong, ZHONG Jinbiao, WANG Qin, LIAO Guiyi. Renal transplantation in 12 pairs of ABO incompatible relatives and literature review[J]. Journal of Shandong University (Health Sciences), 2023, 61(8): 67-73.

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