Department of General Pediatrics, Pediatric Nephrology, University Children's Hospital Münster, Waldeyerstrasse 22, 48149 Münster, Germany.
Pediatr Nephrol. 2011 Jul;26(7):1149-56. doi: 10.1007/s00467-011-1864-3. Epub 2011 Apr 1.
Acute antibody-mediated rejections (aAMR) after renal transplantation are defined by rapidly deteriorating graft function, detection of donor-specific antibodies (DSA) and characteristic histological features. In adults, anti-rejection strategies comprise intravenous immunoglobulin (IVIG), steroid pulses, plasmapheresis and rituximab. Data of children with aAMR are scarce. We report four episodes of aAMR in three children (aged 10, 10 and 11 years respectively) occurring early after renal transplantation. Pre-transplant complement-dependent cytotoxicity crossmatches were negative; in the case of re-transplantation repeated antigens were excluded. Basic immunosuppression comprised cyclosporine A, MMF and steroids. All four rejection episodes were histologically proven and associated with acute renal failure. De novo DSAs were detected in two aAMRs; one patient was additionally tested positive for AT1-receptor antibodies. All aAMRs were treated with steroid pulses, tacrolimus, MMF, IVIG, plasmapheresis and one single dose of rituximab. Despite therapy one graft was lost; in the remaining three cases kidney function re-established within 1-8 weeks. At follow-up, 14, 15 and 22 months' post-rejection their GFRs were 65, 88 and 105 ml/min/1.73 m(2) respectively. A combined therapy of steroid pulses, IVIG, plasmapheresis and rituximab is potentially effective in the treatment of aAMR in children.
急性抗体介导的排斥反应（aAMR）是指肾移植后移植物功能迅速恶化，检测到供体特异性抗体（DSA）和特征性组织学特征。在成人中，抗排斥策略包括静脉注射免疫球蛋白（IVIG）、类固醇脉冲、血浆置换和利妥昔单抗。儿童 aAMR 的数据很少。我们报告了三例儿童（年龄分别为 10 岁、10 岁和 11 岁）在肾移植后早期发生的四例 aAMR 病例。移植前补体依赖性细胞毒性交叉匹配均为阴性；在再次移植的情况下，重复抗原被排除。基本免疫抑制包括环孢素 A、MMF 和类固醇。所有 4 例排斥反应均经组织学证实，并伴有急性肾功能衰竭。在 2 例 aAMR 中检测到新的 DSA；其中 1 例患者还被检测到 AT1 受体抗体阳性。所有 aAMR 均采用类固醇脉冲、他克莫司、MMF、IVIG、血浆置换和单次利妥昔单抗治疗。尽管进行了治疗，但仍有 1 个移植物丢失；在其余 3 例中，肾功能在 1-8 周内恢复。在随访中，排斥反应后 14、15 和 22 个月时，他们的 GFR 分别为 65、88 和 105 ml/min/1.73 m(2)。类固醇脉冲、IVIG、血浆置换和利妥昔单抗联合治疗可能对儿童 aAMR 的治疗有效。
