Pouteil-Noble C, Betuel H, Raffaele P, Robert F, Dubernard J M, Touraine J L
Nephro-Urology, Transplantation, and Clinical Immunology Unit, INSERM U 80, C.N.R.S. U1 1177, University Claude Bernard, Lyon, France.
Transplantation. 1991 Apr;51(4):777-81. doi: 10.1097/00007890-199104000-00008.
The role of platelet transfusion as a preparative method for kidney transplantation is still a matter of debate. Two groups of 28 male patients transplanted between 1983 and 1988, paired for age, date of transplant, absence of anti-HLA antibody and immunosuppressive therapy have been compared. Group I was given 5 purified platelet transfusions at 1-week intervals before transplantation. Each transfusion contained 7.6 x 10(6) platelets contaminated by less than 1 leukocyte in 10(5) platelets. Group II received from 3 to 5 whole blood transfusions. In all cases it was a first transplant from cadaveric donors and previously untransfused patients before entering the protocol. No patient in group I developed cytotoxic antibodies. Acute tubular necrosis occurred with the same incidence in group I and in group II but was more severe and longer in group I, requiring hemodialysis in 62.5% and only 22% in group II. ATN was significantly associated with graft loss in group I (P less than 0.05). The total number of rejections and the number of patients undergoing rejection were not significantly different in both groups. However, the intensity of rejection was significantly higher in group I with 41% (21/51) of severe or irreversible rejections versus 9/46 (19.5%) in group II (P less than 0.05). The first rejection occurred significantly earlier in group I than in group II since 75% of the first rejection episodes occurred in the first 10 days versus 38% in group II (P less than 0.02) with a mean delay of 12.8 +/- 3.2 and 19.10 +/- 3.3 days, respectively. Although platelet transfusions are devoid of leukocytes the incidence of CMV infection was not significantly different in both groups: 57% in group I and 68% in group II. Purified platelet transfusions did not induce humoral immunization but lack of sensitization does not imply indefinite graft prolongation. Because platelets do not carry class II antigens, purified platelets transfusions represent a useful model to analyze the role of class I antigens alone in the induction of unresponsiveness in organ transplantation.
血小板输注作为肾移植预处理方法的作用仍存在争议。对1983年至1988年间进行移植的两组各28名男性患者进行了比较，这两组患者在年龄、移植日期、抗HLA抗体缺失情况及免疫抑制治疗方面相互配对。第一组在移植前每隔1周接受5次纯化血小板输注。每次输注含有7.6×10⁶个血小板，每10⁵个血小板中白细胞污染少于1个。第二组接受3至5次全血输注。所有病例均为首次接受尸体供体移植，且在进入该方案之前均未接受过输血。第一组中没有患者产生细胞毒性抗体。急性肾小管坏死在第一组和第二组中的发生率相同，但在第一组中更严重且持续时间更长，第一组中有62.5%的患者需要血液透析，而第二组中仅为22%。在第一组中，急性肾小管坏死与移植物丢失显著相关（P<0.05）。两组的排斥反应总数及发生排斥反应的患者数量无显著差异。然而，第一组的排斥反应强度显著更高，严重或不可逆排斥反应的发生率为41%（21/51），而第二组为9/46（19.5%）（P<0.05）。第一组的首次排斥反应明显早于第二组，因为75%的首次排斥反应发生在头10天，而第二组为38%（P<0.02），平均延迟时间分别为12.8±3.2天和19.10±3.3天。尽管血小板输注不含白细胞，但两组的巨细胞病毒感染发生率无显著差异：第一组为57%，第二组为68%。纯化血小板输注不会诱导体液免疫，但缺乏致敏并不意味着移植物能无限期延长。由于血小板不携带II类抗原，纯化血小板输注是分析I类抗原单独在器官移植中诱导无反应性作用的有用模型。
