血浆置换在ABO血型不相容的亲属活体肾移植中应用效果评价*

doi:10.3969/j.issn.1671-2587.2021.02.007

临床输血与检验 ›› 2021, Vol. 23 ›› Issue (2): 167-172.DOI: 10.3969/j.issn.1671-2587.2021.02.007

血浆置换在ABO血型不相容的亲属活体肾移植中应用效果评价^*

张媛媛, 应美爱, 潘健, 刘洪涛, 刘潜, 戴帅, 王慧茹, 刘会兰

23000l 合肥,中国科学技术大学附属第一医院安徽省立医院

收稿日期:2020-09-14 出版日期:2021-04-20 发布日期:2021-04-19
通讯作者: 刘会兰,女,主任医师,博士生导师,医学博士,主要从事造血干细胞移植工作,（E-mail）13866771269@163.com。
作者简介:张媛媛（1989-）,女,安徽池州人,主管技师,硕士,主要从事输血医学工作,（E-mail） zyuan224@126.com
基金资助:
*本课题受中央高校基本科研业务费专项资金（No.WK9110000027）资助

The Clinical Effect of Plasma Exchange in ABO Incompatible Relatives in vivo Kidney Transplantation

ZHANG Yuan-yuan, YING Mei-ai, PAN Jian, et al

0Department of Blood Transfusion,the First Affiliated Hospital of University of Science and Technology of China,Hefei 230022

Received:2020-09-14 Online:2021-04-20 Published:2021-04-19

摘要/Abstract

摘要： 目的观察血浆置换在ABO血型不相容亲属活体肾移植中清除血型抗体的临床应用效果。方法回顾分析2017年7月~2019年1月本院54例行ABO血型不相容肾移植患者的临床特征及行血浆置换治疗后血型抗体效价变化情况,分析血浆置换治疗过程中不良反应发生情况。结果 52/54例患者血型抗体（包括IgG和IgM）效价成功降至术前目标滴度,顺利进行肾移植手术;1例患者术后出现血型抗体反弹,移植肾失功;2例患者血型抗体效价未能降至目标水平,放弃肾移植手术,继续行肾脏替代治疗。血浆置换降低ABO血型不相容肾移植受者血型抗体的总有效率为94%。128次血浆置换过程中共发生了49次轻度不良反应。结论血浆置换是降低ABO非同型肾移植受者血型抗体（包括IgG和IgM）的有效方法,可与其他免疫抑制剂联合使用,缩短移植前血型抗体高滴度受者术前预处理时间。

关键词: ABO血型不相容肾移植, 血浆置换, 抗体滴度

Abstract: Objective To observe the clinical effect of plasma exchange in removing blood group antibody in ABO incompatible relatives kidney transplantation. Methods The clinical characteristics of 54 cases of ABO non-identical relatives kidney transplantation in our hospital from July 2017 to January 2019 were analyzed retrospectively, and the changes of blood group antibody titer after plasma exchange treatment were analyzed. Results The titers of blood group antibodies (including IgG and IgM) were successfully reduced to the preoperative target titer in 2/54 patients, and renal transplantation was successfully carried out in 1/52 patients; One patient had the rebound titer of blood group antibody after operation, and the transplanted kidney failed. Two patients did not reduce the titer of blood group antibody to the target level. They gave up the kidney transplantation and continued the hemodialysis replacement treatment. There were 49 mild adverse events in 128 plasma exchange procedures. Conclusion Plasma exchange is an effective method to reduce the blood group antibody (including IgG and IgM) titer of recipients, which can be used in combination with other immunosuppressants to shorten the pre-operation time of patients with high blood group antibody titer.

Key words: ABO incompatible kidney transplantation, Plasma exchange, Antibody titer

中图分类号:

R692.5R457.2

张媛媛, 应美爱, 潘健, 刘洪涛, 刘潜, 戴帅, 王慧茹, 刘会兰. 血浆置换在ABO血型不相容的亲属活体肾移植中应用效果评价^*[J]. 临床输血与检验, 2021, 23(2): 167-172.

ZHANG Yuan-yuan, YING Mei-ai, PAN Jian, et al. The Clinical Effect of Plasma Exchange in ABO Incompatible Relatives in vivo Kidney Transplantation[J]. JOURNAL OF CLINICAL TRANSFUSION AND LABORATORY MEDICINE, 2021, 23(2): 167-172.

参考文献

[1] ROODNAT J I,KAL-VAN GESTEL J A,ZUIDEMA W,et al.Successful expansion of the living donor pool by alternative living donation programs[J].Am J Transplant,2009,9(9):2150-2156.
[2] TANABE K, TAKAHASHI K, SONDA K, et al.Long-term results of ABO-incompatible living kidney transplantation: a single-center experience[J].Transplantation,1998,65(2):224-228.
[3] ZSCHIEDRICH S,KRAMER-ZUCKER A,JÄNIGEN B,et al.An update on ABO-incompatible kidney transplantation[J].Transpl Int,2015,28(4):387-397.
[4] 王毅. ABO血型不相容亲属活体肾移植临床诊疗指南(2017版)[J].中华移植杂志(电子版),2017,11(4):193-200.
[5] 戚贵生,李佳蔚,蒋密,等.ABO血型不相容(ABOi)的亲属肾移植受体个体化预处理的探索[J].复旦学报(医学版),2020,47(1): 31-36
[6] 邱江,陈国栋,阮和欢,等.ABO血型不相容亲属活体肾移植的脱敏治疗[J].中华器官移植杂志,2019,40(8):478-483.
[7] 王显丁,邱阳,吕远航,等.ABO血型不相容亲属活体肾移植的临床分析[J].中华器官移植杂志,2018,39(1):29-34.
[8] HATAKEYAMA S,FUJITA T,MURAKAMI R,et al.Outcome comparison of ABO-incompatible kidney transplantation with low-dose rituximab and ABO-compatible kidney transplantation:a single-center experience[J].Transplant Proc,2014,46(2):445-448.
[9] MURAMATSU M,GONZALEZ H D,CACCIOLA R,et al.ABO incompatible renal transplants:Good or bad?[J].World J Transplant,2014,4(1):18-29.
[10] TOBIAN A A,SHIREY R S,MONTGOMERY R A,et al.ABO antibody titer and risk of antibody-mediated rejection in ABO-incompatible renal transplantation[J].Am J Transplant,2010,10(5):1247-1253.
[11] BÖHMIG G A,FARKAS A M,ESKANDARY F,et al.Strategies to overcome the ABO barrier in kidney transplantation[J].Nat Rev Nephrol,2015,11(12):732-747.
[12] 雷文华,刘帅辉,周静怡,等.不同免疫诱导方案对ABO血型不相容亲属活体肾移植受者临床结局的影响[J].中华器官移植杂志,2019,40(2):78-82.
[13] OKUMI M,KAKUTA Y,UNAGAMI K,et al.Current protocols and outcomes of ABO-incompatible kidney transplantation based on a single-center experience[J].Transl Androl Urol,2019,8(2):126-133.
[14] ISHIDA H,MIYAMOTO N,SHIRAKAWA H,et al.Evaluation of immunosuppressive regimens in ABO-incompatible living kidney transplantation——single center analysis[J].Am J Transplant,2007,7(4): 825-831.
[15] GENBERG H,KUMLIEN G,WENNBERG L,et al.The efficacy of antigen-specific immunoadsorption and rebound of anti-A/B antibodies in ABO-incompatible kidney transplantation[J].Nephrol Dial Transplant,2011,26(7):2394-2400.
[16] TANABE K.Double-filtration plasmapheresis[J].Transplantation,2007,84(12 suppl):S30-S32.
[17] PARMENTIER S P,ROSENKRANZ E, SCHIRUTSCH-KE H,et al.Comparing the efficacy of three techniques to reduce isoagglutinin titers in AB0 incompatible ki-
dney transplant recipients[J].Atheroscler Suppl, 2017, 30:253-256.
[18] TAKAHASHI K,SAITO K,TAKAHARA S,et al.Re-sults of a multicenter prospective clinical study in Japan for evaluating efficacy and safety of desensitization protocol based on rituximab in ABO-incompatible kidney transplantation[J].Clin Exp Nephrol,2017,21(4):705-713.
[19] FLINT S M,WALKER R G,HOGAN C,et al.Successful ABO-incompatible kidney transplantation with antibody removal and standard immunosuppression[J].Am J Transplant,2011,11(5):1016-1024.
[20] JHA P K,TIWARI A K,BANSAL S B,et al.Cascade plasmapheresis as preconditioning regimen for ABO-incompatible renal transplantation:a single-center experience[J].Transfusion,2016,56(4):956-961.

血浆置换在ABO血型不相容的亲属活体肾移植中应用效果评价^*

The Clinical Effect of Plasma Exchange in ABO Incompatible Relatives in vivo Kidney Transplantation

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