Twombley Katherine, Thach Lonnie, Ribeiro Annelise, Joseph Catherine, Seikaly Mouin
Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA.
Pediatr Transplant. 2013 Nov;17(7):E149-55. doi: 10.1111/petr.12129. Epub 2013 Aug 1.
aAMR is a potentially devastating complication of kidney transplantation. The incidence of aAMR in children, while thought to be rare, is not well defined, and there is a paucity of data on treatment regimens in children. We retrospectively reviewed the outcomes of our pediatric patients that were treated for aAMR between 2007 and 2009. Three adolescent Hispanic males were found to have aAMR. All three received deceased donor transplants, and all three verbalized non-adherence. Treatment consisted of rituximab, solumedrol, PE, and IVIgG in one patient, and PE, IVIgG, and bortezomib in two patients. The only side effect of therapy noted was mild hypotension with rituximab that resolved after decreasing the infusion rate. There were no reported infections two yr after treatment, and all of the viral monitoring in these patients remained negative.
急性抗体介导的排斥反应（aAMR）是肾移植中一种潜在的毁灭性并发症。虽然认为儿童aAMR的发病率很低，但尚无明确定义，且关于儿童治疗方案的数据也很匮乏。我们回顾性分析了2007年至2009年间接受aAMR治疗的儿科患者的预后情况。发现有3名西班牙裔青少年男性患有aAMR。这3例均接受了死体供者移植，且均表示未坚持治疗。1例患者的治疗包括利妥昔单抗、甲泼尼龙、血浆置换（PE）和静脉注射免疫球蛋白（IVIgG），2例患者的治疗包括PE、IVIgG和硼替佐米。所记录的治疗唯一副作用是使用利妥昔单抗时出现轻度低血压，在降低输注速率后症状缓解。治疗后两年没有报告感染情况，这些患者的所有病毒监测结果均为阴性。
