移植肾术后急性抗体介导性排斥反应的诊断与治疗
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摘要
目的观察肾功能不全移植肾术后3个月内急性抗体介导性排斥反应的诊断和治疗方法。方法肾移植术后患者106例,均在B超引导下行移植肾穿刺活检组织病理检查,观察移植肾病理改变情况;采用免疫组织化学染色观察移植肾C4d表达情况;确诊急性抗体介导性排斥反应后给予血浆置换和静脉注射小剂量丙种球蛋白等治疗,观察治疗效果。结果移植肾超急性排斥反应2例,急性抗体介导性排斥反应15例;免疫组织化学染色示C4d均为阳性;2例超急性排斥反应移植肾失功,移植肾切除;15例急性抗体介导性排斥反应患者中13例治疗后移植肾功能恢复,2例移植肾功能未恢复,血肌酐稳定于较高水平。结论移植肾穿刺活检组织病理对肾移植术后移植肾功能不全的诊断有重要意义,血浆置换及静脉注射小剂量丙种球蛋白在肾功能不全移植肾术后急性抗体介导性排斥反应治疗中有积极作用。
Objective To explore the diagnosis and treatment of acute antibody-mediated rejection in perioperative 3 months after renal transplantation in patients with renal insufficiency.Methods The graft kidneys in 106 patients received ultrasound-guided biopsy after renal transplantation.The pathological changes were observed by the pathological method.C4 dexpression was detected by immunohistochemical staining.Acute antibody-mediated rejection was treated by plasmapheresis and intravenous immunoglobulin.The therapeutic effect was observed.Results Hyperacute rejection occurred in 2 patients and acute antibody-mediated rejection occurred in 15.C4 dimmunohistochemical staining was positive.After treatment,renal function failure occurred in 2 patients with hyperacute rejection,and resection of graft kidney was performed.In 15 patients with antibody-mediated rejection,renal function was recovered in 13 and creatinine remained a high level in the other 2 patients with unrecovered renal function.Conclusion Renal puncture biopsy has an important guiding significance in the diagnosis of renal insufficiency after renal transplantation.Plasmapheresis plus low dose intravenous immunoglobulin is effective for acute antibody-mediated rejection after renal transplantation for renal insufficiency.
Objective To explore the diagnosis and treatment of acute antibody-mediated rejection in perioperative 3 months after renal transplantation in patients with renal insufficiency.Methods The graft kidneys in 106 patients received ultrasound-guided biopsy after renal transplantation.The pathological changes were observed by the pathological method.C4 dexpression was detected by immunohistochemical staining.Acute antibody-mediated rejection was treated by plasmapheresis and intravenous immunoglobulin.The therapeutic effect was observed.Results Hyperacute rejection occurred in 2 patients and acute antibody-mediated rejection occurred in 15.C4 dimmunohistochemical staining was positive.After treatment,renal function failure occurred in 2 patients with hyperacute rejection,and resection of graft kidney was performed.In 15 patients with antibody-mediated rejection,renal function was recovered in 13 and creatinine remained a high level in the other 2 patients with unrecovered renal function.Conclusion Renal puncture biopsy has an important guiding significance in the diagnosis of renal insufficiency after renal transplantation.Plasmapheresis plus low dose intravenous immunoglobulin is effective for acute antibody-mediated rejection after renal transplantation for renal insufficiency.
引文
[1]韩永,黄海燕,许晓光,等.移植肾穿刺组织病理学检查及临床分析[J].中华实用诊断与治疗杂志,2010,24(12):1173-1178.
[2]Randhawa PS,Schonder K,Shapiro R,et al.Polyomavirus BK neutralizing activity in human immunoglobulin preparations[J].Transplantation,2010,89(12):1462-1465.
[3]韩永,郭晖,蔡明,等.移植肾活检:病理及组织学的早期诊断价值[J].中国组织工程研究,2013,17(5):785-790.
[4]向雪宝.肾移植围手术期目标导向性液体治疗进展[J].器官移植,2014,5(3):191-193.
[5]蔡文利,郭晖,苗书斋,等.移植肾围手术期穿刺活检116例结果分析[J].郑州大学学报:医学版,2009,45(5):871-872.
[6]徐秀红,贾保祥.供者特异性抗体对肾移植术后患者急性排斥和肾功能的影响研究[J].临床和实验医学杂志,2014,13(2):92-95.
[7]Othman MM,Ismael AZ,Hammouda GE.The impact of timing of maximal crystalloid hydration on early graft function during kidney transplantation[J].Anesth Analg,2010,110(5):1440-1446.
[8]庞新路,丰贵文,尚文俊,等.红花黄色素改善移植肾早期肾功能疗效观察[J].中华实用诊断与治疗杂志,2014,28(3):298-300.
[9]李纬明,陈维安,陈连周,等.移植肾的99 Tcm DTPA肾动态监测[J].中华全科医学,2009,7(2):117-118.
[10]Tyan DB,Li VA,Czer L,et al.Intravenous immunoglobulin suppression of HLA alloantibody in highly sensitized transplant candidates and transplantation with a histoincompatible organ[J].Transplantation,1994,57(4):553-562.
[11]Montgomery RA,Zachary AA,Racusen LC,et al.Plasmepheresis and intravenous immune globulin provides effective rescue therapy for refractory humoral rejection and allows kidneys to be successfully transplanted into cross match positive recipients[J].Transplantion,2000,70(6):887-895.
[12]Casadei D,Rial M,Argento J,et al.Preliminary results from a randomized and prospective study of high-dose immunoglobulin versus monoclonal antibody in the rescue of steroid-resistant rejections[J].Transplant Proc,1998,30(5):2164.
[2]Randhawa PS,Schonder K,Shapiro R,et al.Polyomavirus BK neutralizing activity in human immunoglobulin preparations[J].Transplantation,2010,89(12):1462-1465.
[3]韩永,郭晖,蔡明,等.移植肾活检:病理及组织学的早期诊断价值[J].中国组织工程研究,2013,17(5):785-790.
[4]向雪宝.肾移植围手术期目标导向性液体治疗进展[J].器官移植,2014,5(3):191-193.
[5]蔡文利,郭晖,苗书斋,等.移植肾围手术期穿刺活检116例结果分析[J].郑州大学学报:医学版,2009,45(5):871-872.
[6]徐秀红,贾保祥.供者特异性抗体对肾移植术后患者急性排斥和肾功能的影响研究[J].临床和实验医学杂志,2014,13(2):92-95.
[7]Othman MM,Ismael AZ,Hammouda GE.The impact of timing of maximal crystalloid hydration on early graft function during kidney transplantation[J].Anesth Analg,2010,110(5):1440-1446.
[8]庞新路,丰贵文,尚文俊,等.红花黄色素改善移植肾早期肾功能疗效观察[J].中华实用诊断与治疗杂志,2014,28(3):298-300.
[9]李纬明,陈维安,陈连周,等.移植肾的99 Tcm DTPA肾动态监测[J].中华全科医学,2009,7(2):117-118.
[10]Tyan DB,Li VA,Czer L,et al.Intravenous immunoglobulin suppression of HLA alloantibody in highly sensitized transplant candidates and transplantation with a histoincompatible organ[J].Transplantation,1994,57(4):553-562.
[11]Montgomery RA,Zachary AA,Racusen LC,et al.Plasmepheresis and intravenous immune globulin provides effective rescue therapy for refractory humoral rejection and allows kidneys to be successfully transplanted into cross match positive recipients[J].Transplantion,2000,70(6):887-895.
[12]Casadei D,Rial M,Argento J,et al.Preliminary results from a randomized and prospective study of high-dose immunoglobulin versus monoclonal antibody in the rescue of steroid-resistant rejections[J].Transplant Proc,1998,30(5):2164.