通过移植前血浆置换使之前阳性的流式细胞术交叉配型转为阴性后，成功进行了高成功率的活体供肾移植。

Highly successful living donor kidney transplantation after conversion to negative of a previously positive flow-cytometry cross-match by pretransplant plasmapheresis.

作者信息

Thielke J, DeChristopher P J, Sankary H, Oberholzer J, Testa G, Benedetti E

机构信息

Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, Illinois 60612, USA.

出版信息

Transplant Proc. 2005 Mar;37(2):643-4. doi: 10.1016/j.transproceed.2004.12.063.

DOI:10.1016/j.transproceed.2004.12.063

PMID:15848486

Abstract

Between July 2001 and November 2003, 16 patients with a positive flow-cytometry crossmatch to their potential living donor for kidney transplant were treated with desensitization protocol based on plasmapheresis and low-dose IVIg starting 1 week before the scheduled transplant. Twelve patients (75%) converted to negative crossmatch and were successfully transplanted. Immunosuppression consisted of induction with thymoglobulin, tacrolimus, mycophenolate mofetil, and steroids. Plasmapheresis and IVIg were continued on alternate days for the first postoperative week. The 1-year patient and graft survival was 100%. The rate of acute rejection was 41% (16% cellular and 25% humoral). All of the rejection episodes resolved with treatment. Combination of plasmapheresis and IVIg allows successful conversion from positive to negative flow-cytometry crossmatch in 75% of cases; after conversion, kidney transplant can be carried out with a high rate of success.

摘要

2001年7月至2003年11月期间，16例与潜在活体供肾者流式细胞术交叉配型阳性的肾移植患者，在预定移植前1周开始接受基于血浆置换和小剂量静脉注射免疫球蛋白的脱敏方案治疗。12例患者（75%）交叉配型转为阴性并成功进行了移植。免疫抑制包括使用抗胸腺细胞球蛋白诱导、他克莫司、霉酚酸酯和类固醇。术后第一周每隔一天继续进行血浆置换和静脉注射免疫球蛋白。1年的患者和移植物存活率均为100%。急性排斥反应发生率为41%（细胞性16%，体液性25%）。所有排斥反应经治疗后均得到缓解。血浆置换和静脉注射免疫球蛋白联合应用可使75%的病例成功实现流式细胞术交叉配型由阳性转为阴性；转为阴性后，肾移植成功率很高。