Rufino Hernández J M, Cabello Moya E, González-Posada J M, Hernández Marrero D, Pérez Tamajón L, Marrero Miranda D, García Rebollo S, Martín Urcuyo B, Rodríguez Hernández A, Franco Maside A, Barrios del Pino Y, Rodríguez Rodríguez R, Maceira Cruz B, Torres Ramírez A, Salido Ruiz E
Servicio de Nefrología, Hospital Universitario de Canarias, Tenerife.
Nefrologia. 2010;30(2):252-7. doi: 10.3265/Nefrologia.pre2010.Jan.10233. Epub 2010 Jan 22.
In our Universitary Hospital of Canarias we iniciated in May 2008 a induction therapy protocol for sensitized patients receiving cadaveric renal graft using intravenous immunoglobulins, plasmapheresis and rituximab plus immunosuppression with prednisone, tacrolimus and mycophenolate mofetil. We present the results of four patients. Everyone had anti-HLA antibodies rate (PRA by CDC) more than 75%, were on a waiting list during 4 to 17 years and follow-up time was 10-14 months after transplantation. Patient and graft survival in this period was 100%. Only one patient suffered a humoral acute rejection and another one cellular rejection, in both cases reversible with treatment. During the first year, no evidence of de novo donor-specific antibodies was detected. All patients had significantly reduced the CD19+ cells percentage after infusion of rituximab. Neurological symptoms suggestive of progressive multifocal leukoencephalopathy or serious viral infections after transplantation have not been observed. Additionally, no immediate side effects were observed after administration of medication. In summary, induction therapy by combining immunoglobulin, plasmapheresis and rituximab in hypersensitive patients allows the realization of deceased kidney transplantation with good results in the short and medium-term without serious side effects. It remains to know whether this success will continue in the long term.
2008年5月，我们在加那利群岛大学医院启动了一项针对接受尸体肾移植的致敏患者的诱导治疗方案，该方案采用静脉注射免疫球蛋白、血浆置换、利妥昔单抗，并联合使用泼尼松、他克莫司和霉酚酸酯进行免疫抑制。我们展示了4例患者的治疗结果。所有患者的抗HLA抗体率（补体依赖细胞毒试验检测的群体反应性抗体）均超过75%，在等待名单上等待了4至17年，移植后的随访时间为10至14个月。在此期间，患者和移植物存活率均为100%。仅1例患者发生了体液性急性排斥反应，另1例发生了细胞性排斥反应，两例经治疗后均可逆。在第一年，未检测到新生供体特异性抗体的证据。所有患者在输注利妥昔单抗后，CD19+细胞百分比均显著降低。未观察到提示进行性多灶性白质脑病或移植后严重病毒感染的神经系统症状。此外，给药后未观察到即刻副作用。总之，对于超敏患者，联合使用免疫球蛋白、血浆置换和利妥昔单抗进行诱导治疗，可实现尸体肾移植，在短期和中期效果良好，且无严重副作用。长期来看这种成功是否会持续仍有待观察。
