摘要
目的探讨针对高滴度ABO血型不相容肾移植(ABOi-KT)的血浆置换(PE)与双重滤过血浆置换(DFPP)预处理方案的临床疗效。方法回顾性分析2016年4月至2025年8月复旦大学附属中山医院收治的31例随访期≥1年的ABOi-KT病例,比较分析PE联合利妥昔单抗(RTX)+口服三联免疫抑制方案与DFPP联合RTX+口服三联免疫抑制方案的疗效差异,监测术前和术后血型抗体滴度、血清肌酐水平,采用Kaplan-Meier法绘制生存曲线、累计风险发生曲线,分析受者及移植肾存活率及并发症发生情况。结果PE方案和DFPP方案均能有效将受者术前血型抗体滴度降至≤1∶16。受者术后1年存活率、移植肾1年存活率均达100%。DFPP方案受者术后血清肌酐水平更低且更稳定,相同随访期内两种方案并发症发生率差异无统计学意义。结论PE与DFPP方案均为ABOi-KT有效预处理方案,DFPP方案在减少治疗操作、降低药物用量及维持术后肾功能稳定方面更具优势。针对高初始抗体滴度(≥1∶32)受者,个体化制定血浆处理的次数和频率进行预处理可实现理想疗效。
Objective To explore the clinical efficacy of plasma exchange(PE)and double-filtration plasmapheresis(DFPP)pretreatment regimens for high-titer ABO-incompatible kidney transplantation(ABOi-KT).Methods A retrospective analysis was conducted on 31 cases of ABOi-KT with a follow-up period≥1 year admitted to Zhongshan Hospital Affiliated to Fudan University from April 2016 to August 2025.The efficacy differences between the PE combined with rituximab(RTX)+oral triple immunosuppressive regimen and the DFPP combined with RTX+oral triple immunosuppressive regimen were compared and analyzed.The titers of blood group antibodies and serum creatinine levels before and after the operation were monitored.The survival curves and cumulative risk occurrence curves were plotted using the Kaplan-Meier method.The survival rates of recipients and transplanted kidneys and the occurrence of complications were analyzed.Results Both the PE regimen and the DFPP regimen may effectively reduce the preoperative blood group antibody titer of the recipients to≤1∶16.The one-year survival rate of the recipients and the transplanted kidneys both reached 100%after the operation.The postoperative serum creatinine levels of recipients who received the DFPP regimen were lower and more stable.There was no statistically significant difference in the incidence of complications between the two regimens during the same follow-up period.Conclusions Both the PE and DFPP regimens are effective pretreatment regimens for ABOi-KT.The DFPP regimen has more advantages in reducing treatment operations,lowering drug dosage and maintaining the stability of postoperative renal function.For recipients with a high initial antibody titer(≥1∶32),individualized determination of the number and frequency of plasma processing for pretreatment may achieve ideal therapeutic effects.
作者
梁厉飞
戚贵生
周蓉
桑瑞瑞
杨橙
Liang Lifei;Qi Guisheng;Zhou Rong;Sang Ruirui;Yang Cheng(Department of Kidney Transplantation,Zhongshan Hospital Affiliated Fudan University,Shanghai 200032,China;不详)
出处
《器官移植》
北大核心
2026年第1期68-76,共9页
Organ Transplantation
基金
国家自然科学基金面上项目(82370754、82170765)。
关键词
ABO血型不相容肾移植
血浆置换
双重滤过血浆置换
血型抗体滴度
移植肾存活率
慢性肾病
血液透析
腹膜透析
ABO-incompatible kidney transplantation
Plasma exchange
Double-filtration plasmapheresis
Blood type antibody titer
Graft survival rate
Chronic kidney disease
Hemodialysis
Peritoneal dialysis
