Kidney Transplantation Program, Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
Chin Med J (Engl). 2009 Nov 20;122(22):2752-6.
The number of highly sensitized patients is rising, and sensitization can lead to renal transplant failure. The present study aimed to investigate the safety and efficacy of protein A immunoadsorption combined with rituximab (RTX) in highly sensitized recipients of kidney transplants.
Seven highly sensitized recipients of living-related renal transplants (4 men and 3 women, mean aged 42.5 years old (range 33 - 51)) were pretreated with this combination. Human leukocyte antigen (HLA) mismatch number was 2 - 5. Panel reactive antibody (PRA) of class I was high in 2 cases and that of class II was high in 1 case. All patients were pretreated with immunoadsorption 2 - 10 times. Immunoglobulin and PRA changes were monitored before and after absorption. The operation was conducted when PRA or immunoglobulin levels were at or below normal levels. Immunosuppressive drugs were provided 3 - 5 days before the operation, and one dose of RTX (375 mg/m(2)) was infused with polyclonal antibody on the day of operation. Postoperative creatinine (Cr), creatinine clearance rate (Ccr), PRA ratio, and immunoglobulin changes were monitored.
All 7 patients had good recovery without delayed graft function. Acute rejection occurred in 3 cases at postoperative days 8, 10, and 14, respectively. The Banff 07 biopsy grades were Ia in 1 case and IIa C4d0 in 2 cases. Successful reversion was achieved after giving methylprednisolone or antithymocyte immunoglobulin + cyclophosphamide. All patients were discharged with normal renal function, mean class I PRA was 14% and mean class II PRA was 35%. PRA was completely negative in 3 cases.
Protein A immunoadsorption combined with RTX can safely reduce the occurrence of humoral rejection in highly sensitized renal transplant recipients.
高度致敏患者的数量正在增加，致敏可导致肾移植失败。本研究旨在探讨蛋白 A 免疫吸附联合利妥昔单抗（RTX）在高度致敏的肾移植受者中的安全性和疗效。
7 例活体亲属肾移植的高度致敏受者（4 男 3 女，平均年龄 42.5 岁（范围 33-51））接受了该联合治疗。HLA 错配数为 2-5。2 例患者的Ⅰ类群体反应性抗体（PRA）高，1 例患者的Ⅱ类 PRA 高。所有患者均接受免疫吸附治疗 2-10 次。在吸收前后监测免疫球蛋白和 PRA 的变化。当 PRA 或免疫球蛋白水平达到或低于正常水平时进行手术。手术前 3-5 天给予免疫抑制剂，手术当天输注 375mg/m(2)的 RTX 和多克隆抗体。术后监测血肌酐（Cr）、肌酐清除率（Ccr）、PRA 比值和免疫球蛋白变化。
7 例患者均恢复良好，无移植肾功能延迟恢复。术后第 8、10、14 天分别有 3 例出现急性排斥反应。Banff 07 活检分级分别为 Ia 1 例、IIa C4d0 2 例。给予甲基强的松龙或抗胸腺细胞免疫球蛋白+环磷酰胺后均成功逆转。所有患者肾功能正常出院，平均Ⅰ类 PRA 为 14%，平均Ⅱ类 PRA 为 35%。3 例 PRA 完全转阴。
蛋白 A 免疫吸附联合 RTX 可安全降低高度致敏肾移植受者发生体液性排斥反应的风险。
