早期低剂量利妥昔单抗在ABO血型不相容肾移植中的应用

发布时间：2019-03-21 13:35

【摘要】：目的探讨不同方案利妥昔单抗在ABO血型不相容肾移植(ABOi-KT)中应用的利弊,总结合理利用利妥昔单抗使用方案。方法 33例ABOi-KT受者,术前均使用MMF+FK506等10~14 d,配合血浆置换和血浆双重滤过。利妥昔单抗的使用有如下4个不同方案:方案一,术前24 h内单次使用利妥昔单抗500 mg;方案二,术前1周和术前24 h内各使用利妥昔单抗500 mg;方案三,术前2周、术前1周和术前24 h内分别使用利妥昔单抗200、200、500 mg;方案四:术前2周、术前1周和术前24 h内分别使用利妥昔单抗200、200、100 mg。监测4组患者不同时间点血型抗体滴度。统计各组血浆处理次数、使用血浆量,比较不同组别对比术后人肾脏存活率、1年内的感染发生率。结果除方案二中1例出现急性排斥反应,行移植肾切除外,余32例ABOi-KT均取得成功,未出现大出血和肾功能延迟恢复。方案一配合血浆置换和血浆双重滤过次数最多,使用血液制品也最多,方案三和四最少;方案三和四中术后2周内血型抗体滴度反弹较其他方案慢。结论 (1)联合应用免疫抑制剂、血浆置换和(或)双重血浆置换、利妥昔单抗等方法处理ABOi-KT受者是安全有效的;(2)早期低剂量使用利妥昔单抗方案(方案四)是安全有效的,同时可以减少移植受者血浆处理次数,减少术后血型抗体反弹概率,减少手术费用。
[Abstract]:Objective To study the advantages and disadvantages of the application of rituximab in ABO incompatible kidney transplantation (ABBOi-KT) and to sum up the rational use of rituximab. Methods 33 patients with ABOi-KT were treated with MMF + FK506 for 10-14 days before operation, and the plasma replacement and plasma double filtration were used. The use of rituximab has the following four different protocols:1. Single use of rituximab for 500 mg in 24 h before operation; regimen II, use of rituximab in 500 mg for each of the pre-operative 1-week and pre-operative 24 h; and 3,2 weeks before operation, Rituximab (200,200,500 mg) was used in the first and 24 hours before and after the operation, and the rituximab (200,200,100 mg) was used in the first 2 weeks before the operation,1 week before the operation and 24 hours before the operation. Blood group antibody titres at different time points in 4 groups were monitored. The number of plasma treatment in each group was counted, the plasma volume was used, and the survival rate of the human kidney after comparison with different groups was compared, and the rate of infection in 1 year was compared. Results Except for acute rejection in 1 of the second group,32 patients with ABOi-KT were successful after the nephrectomy, and no major bleeding and delayed renal function were found. Protocol I was the most frequently used for plasma replacement and plasma double filtration, and the maximum number of blood products was used, and the protocol was at least 3 and 4; the antibody titer of the blood group in the two weeks after operation in the three and four groups of the protocol was slower than that of other schemes. Conclusion (1) It is safe and effective to treat ABOi-KT recipients in combination with immunosuppressants, plasma replacement and/ or double plasma replacement, rituximab and other methods; (2) the early low dose of rituximab (Scheme IV) is safe and effective. At the same time, the number of plasma treatment of the transplant recipient can be reduced, the probability of the rebound of the blood group antibody after operation is reduced, and the operation cost is reduced.
【作者单位】：南华大学附属第二医院泌尿外科;南华大学附属第二医院临床研究所;南华大学第二临床学院;
【基金】：国家自然科学基金资助项目(编号:3097299) 南华大学“蒸湘学者计划”资助
【分类号】：R699.2

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