Higgins Rob, Lowe David, Hathaway Mark, Lam For T, Kashi Habib, Tan Lam Chin, Imray Chris, Fletcher Simon, Chen Klaus, Krishnan Nithya, Hamer Rizwan, Zehnder Daniel, Briggs David
Transplant Unit, University Hospitals Coventry and Warwickshire, Coventry, UK.
Ther Apher Dial. 2010 Aug 1;14(4):392-9. doi: 10.1111/j.1744-9987.2010.00821.x.
Double filtration plasmapheresis (DFPP) was used in preference to plasma exchange in our program of antibody-incompatible transplantation, to treat higher volumes of plasma. Forty-two patients had 259 sessions of DFPP, 201 pre-transplant and 58 post-transplant. At the first treatment session, the mean plasma volume treated was 3.81 L (range 3-6 L), 55.5 mL/kg (range 36.2-83.6 mL/kg). Serum IgG fell by mean 59.4% (SD 10.2%), and IgM by 69.3% (SD 16.1%). Nine patients did not require increases in plasma volumes treated, and six did not tolerate higher plasma volumes. In the remaining patients, the mean maximum plasma volume treated pre-transplant was 6.67 L (range 4-15 L), 96.1 mL/kg (range 60.2-208.9 mL/kg). The complement dependent cytotoxic crossmatch was positive in 14 cases pre-treatment, and remained positive in six (42.8%) cases. The flow cytometric crossmatch was positive in 29 cases pre-treatment, and in 21 (72.4%) after DFPP. Post-transplant, DFPP was ineffective at reducing donor specific antibody levels during periods of rapid donor specific antibody synthesis. Post-transplant, the one year graft survival rate was 94%, although there was a high rate of early rejection. In summary, DFPP enabled the treatment of plasma volumes that were almost double those that would have been feasible with plasma exchange. Despite this, most patients were transplanted with a positive crossmatch, and DFPP post-transplant was unable to control rising antibody levels.
在我们的抗体不相容移植项目中，优先使用双重滤过血浆置换（DFPP）而非血浆置换来处理更大容量的血浆。42例患者接受了259次DFPP治疗，其中移植前201次，移植后58次。在首次治疗时，平均处理的血浆量为3.81升（范围3 - 6升），即55.5毫升/千克（范围36.2 - 83.6毫升/千克）。血清IgG平均下降59.4%（标准差10.2%），IgM下降69.3%（标准差16.1%）。9例患者无需增加处理的血浆量，6例无法耐受更高的血浆量。在其余患者中，移植前平均最大处理血浆量为6.67升（范围4 - 15升），即96.1毫升/千克（范围60.2 - 208.9毫升/千克）。补体依赖细胞毒交叉配型在治疗前14例呈阳性，治疗后6例（42.8%）仍为阳性。流式细胞术交叉配型在治疗前29例呈阳性，DFPP治疗后21例（72.4%）呈阳性。移植后，在供体特异性抗体快速合成期间，DFPP在降低供体特异性抗体水平方面无效。移植后，尽管早期排斥率较高，但一年移植物存活率为94%。总之，DFPP能够处理的血浆量几乎是血浆置换可行量的两倍。尽管如此，大多数患者移植时交叉配型仍为阳性，且移植后DFPP无法控制抗体水平的上升。
