肾移植联合脾窝辅助性肝移植在治疗高致敏受者中的临床应用

发布时间：2018-04-14 20:38

  本文选题：高致敏 + 肾移植　； 参考：《第四军医大学》2015年硕士论文

【摘要】：背景:肾脏移植技术在治疗终末期肾疾病患者中已经成为了最有效的治疗措施之一。然而有过移植、妊娠、输血经历的一部分患者,其体内的群体反应性抗体(panel-reactive antibodies PRA)往往比较高而处于移植前的“预致敏”状态。过高的PRA使得受者体内存在抗供者特异性抗体(donor specific antibody DSA)的几率增大。这种受者体内预先存在的DSA,被认为是引起移植术后超急性排斥反应发生的主要原因。而超急性排异反应一旦发生除了切除移植肾脏之外,目前尚无很好的解决办法。因此,在许多移植中心都将检测PRA作为候选移植受者的指标之一。预致敏受者想要找到配型良好的肾源有着极大的难度。在国内,极度稀缺的肾源通常都移植给了PRA和DSA阴性受者。这使得相当数量的预致敏移植受者长时间的处于等待之中,只能以持续透析进行治疗。因此,找到一种合适的治疗方案,让他们能像其他常规肾移植受者一样,能够及时的得到肾移植治疗并且减少或者避免移植后超急性排斥反应的发生,显得非常必要。为了更好的解决尿毒症患者在高致敏状态下难以进行肾移植的难题,西京医院泌尿外科院于2014年3月6日对一例PRAⅠ类31%、Ⅱ类63%的高致敏尿毒症受者实施了肾移植联合脾窝异位辅助性肝移植术。该术式以保护移植肾免于发生超急性排斥反应为目的,首次使用肾移植联合脾窝异位辅助性肝移植术来治疗高致敏受者。目的:探讨肾移植联合脾窝异位辅助性肝移植在治疗1例高致敏尿毒症受者中的有效性及安全性方法:我们对移植受者术前、术中以及术后各个观测时间点的血清进行了收集。并通过Luminex检测技术检测了受者体内所有预存抗体变化情况,以此来验证脾窝辅助性移植肝在整个移植过程中是否对移植肾同样具有保护作用效果。同时,在各个时间点收集的血清中检测DSA以及与供者人类白细胞抗原(HLA)特异性结合的C1q抗体(C1q-HLA)的变化情况,以此来观察肾移植联合脾窝辅助性肝移植术后受体的体液排斥反应状况。结果:术后未发生超急性排异反应。术后第7天预存抗体水平回升,经治疗后降低,移植肾功能恢复正常。在12个月的随访期间:移植物血液灌注及功能状况良好,预存抗体、DSA及C1q-HLA抗体水平都逐渐下降。结论:利用来自同一供体部分肝脏的保护效应,肾移植联合脾窝异位辅助性肝移植可以有效解决尿毒症患者在高致敏状态下不能进行肾移植的问题。
[Abstract]:Background: renal transplantation has become one of the most effective methods in the treatment of end-stage renal diseases.However, some patients who have experienced transplantation, pregnancy, and blood transfusion, the body of the group reactive antibodies preparation is often high and is in the pre-transplant "presensitivity" state.Excessive PRA increased the risk of donor specific antibody DSAs in recipients.The preexisting DSAs in recipients are thought to be the main cause of hyperacute rejection after transplantation.However, once hyperacute rejection occurs, there is no good solution in addition to the removal of the transplanted kidney.Therefore, the detection of PRA is considered as one of the indicators for candidate transplant recipients in many transplant centers.It is very difficult for presensitive recipients to find a well-matched kidney source.In the country, extremely scarce kidney sources are usually transplanted to PRA and DSA negative recipients.This leaves a significant number of presensitized transplant recipients waiting long enough to be treated with continuous dialysis.Therefore, it is very necessary to find a suitable treatment scheme so that they can get kidney transplantation treatment in time and reduce or avoid the occurrence of hyperacute rejection like other normal renal transplant recipients.In order to better solve the problem that uremia patients are difficult to carry out kidney transplantation under the condition of high sensitivity,On March 6, 2014, Urology Department of Xijing Hospital performed renal transplantation combined with splenic fossa heterotopic liver transplantation in a case of PRA class 鈪，

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