Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Key Laboratory of Organ Transplantation, Ministry of Education and Ministry of Health, Wuhan, 430030, China.
Front Med. 2011 Mar;5(1):80-5. doi: 10.1007/s11684-011-0115-0. Epub 2011 Mar 17.
Highly sensitized patients experience an increased number of rejection episodes and have poorer graft survival rates; hence, sensitization is a significant barrier to both access to and the success of organ transplantation. This study reports our experience in kidney transplantation in highly sensitized patients. Fourteen patients with sensitization or high levels of panelreactive antibodies (PRA) were studied. All patients were desensitized with pre-transplant intravenous immunoglobulin (IVIG)/plasmapheresis (PP) with or without rituximab and thymoglobulin induction therapy, combined with a Prograf/MMF/Pred immunosuppressive regimen. Of 14 patients, 10 showed good graft functions without acute rejection (AR) episodes. Acute cellular rejection in two patients was reversed by methylprednisolone. Two patients underwent antibody-mediated rejection; one was treated with PP/IVIG successfully, whereas the other lost graft functions due to the de novo production of donor-specific antibodies (DSA). Graft functions were stable, and there were no AR episodes in other patients. Conclusively, desensitization using PP/IVIG with or without rituximab increases the likelihood of successful live-donor kidney transplantation in sensitized recipients.
高度致敏患者经历更多的排斥反应发作，且移植物存活率较低；因此，致敏是器官移植获得和成功的重大障碍。本研究报告了我们在高度致敏患者肾移植中的经验。研究了 14 名致敏或高群体反应性抗体 (PRA) 的患者。所有患者均接受了移植前静脉免疫球蛋白 (IVIG)/血浆置换 (PP) 联合或不联合利妥昔单抗和胸腺球蛋白诱导治疗进行脱敏，同时接受普乐可复/霉酚酸酯/泼尼松免疫抑制方案治疗。在 14 名患者中，有 10 名患者显示出良好的移植物功能，没有急性排斥反应 (AR) 发作。两名患者的急性细胞性排斥反应经甲泼尼龙逆转。两名患者发生抗体介导的排斥反应；一名患者经 PP/IVIG 治疗成功，另一名患者因供体特异性抗体 (DSA) 的新产生而失去移植物功能。移植物功能稳定，其他患者无 AR 发作。总之，使用 PP/IVIG 联合或不联合利妥昔单抗进行脱敏可增加致敏受者成功进行活体供肾移植的可能性。
