【摘要】：目的探討不同方案利妥昔單抗在ABO血型不相容腎移植(ABOi-KT)中應(yīng)用的利弊,總結(jié)合理利用利妥昔單抗使用方案。方法 33例ABOi-KT受者,術(shù)前均使用MMF+FK506等10~14 d,配合血漿置換和血漿雙重濾過。利妥昔單抗的使用有如下4個(gè)不同方案:方案一,術(shù)前24 h內(nèi)單次使用利妥昔單抗500 mg;方案二,術(shù)前1周和術(shù)前24 h內(nèi)各使用利妥昔單抗500 mg;方案三,術(shù)前2周、術(shù)前1周和術(shù)前24 h內(nèi)分別使用利妥昔單抗200、200、500 mg;方案四:術(shù)前2周、術(shù)前1周和術(shù)前24 h內(nèi)分別使用利妥昔單抗200、200、100 mg。監(jiān)測4組患者不同時(shí)間點(diǎn)血型抗體滴度。統(tǒng)計(jì)各組血漿處理次數(shù)、使用血漿量,比較不同組別對比術(shù)后人腎臟存活率、1年內(nèi)的感染發(fā)生率。結(jié)果除方案二中1例出現(xiàn)急性排斥反應(yīng),行移植腎切除外,余32例ABOi-KT均取得成功,未出現(xiàn)大出血和腎功能延遲恢復(fù)。方案一配合血漿置換和血漿雙重濾過次數(shù)最多,使用血液制品也最多,方案三和四最少;方案三和四中術(shù)后2周內(nèi)血型抗體滴度反彈較其他方案慢。結(jié)論 (1)聯(lián)合應(yīng)用免疫抑制劑、血漿置換和(或)雙重血漿置換、利妥昔單抗等方法處理ABOi-KT受者是安全有效的;(2)早期低劑量使用利妥昔單抗方案(方案四)是安全有效的,同時(shí)可以減少移植受者血漿處理次數(shù),減少術(shù)后血型抗體反彈概率,減少手術(shù)費(fèi)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.
【作者單位】： 南華大學(xué)附屬第二醫(yī)院泌尿外科;南華大學(xué)附屬第二醫(yī)院臨床研究所;南華大學(xué)第二臨床學(xué)院;
【基金】：國家自然科學(xué)基金資助項(xiàng)目(編號:3097299) 南華大學(xué)“蒸湘學(xué)者計(jì)劃”資助
【分類號】：R699.2

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