本文選題：高致敏 + 腎移植　； 參考：《第四軍醫(yī)大學(xué)》2015年碩士論文

【摘要】：背景:腎臟移植技術(shù)在治療終末期腎疾病患者中已經(jīng)成為了最有效的治療措施之一。然而有過移植、妊娠、輸血經(jīng)歷的一部分患者,其體內(nèi)的群體反應(yīng)性抗體(panel-reactive antibodies PRA)往往比較高而處于移植前的“預(yù)致敏”狀態(tài)。過高的PRA使得受者體內(nèi)存在抗供者特異性抗體(donor specific antibody DSA)的幾率增大。這種受者體內(nèi)預(yù)先存在的DSA,被認(rèn)為是引起移植術(shù)后超急性排斥反應(yīng)發(fā)生的主要原因。而超急性排異反應(yīng)一旦發(fā)生除了切除移植腎臟之外,目前尚無很好的解決辦法。因此,在許多移植中心都將檢測PRA作為候選移植受者的指標(biāo)之一。預(yù)致敏受者想要找到配型良好的腎源有著極大的難度。在國內(nèi),極度稀缺的腎源通常都移植給了PRA和DSA陰性受者。這使得相當(dāng)數(shù)量的預(yù)致敏移植受者長時(shí)間的處于等待之中,只能以持續(xù)透析進(jìn)行治療。因此,找到一種合適的治療方案,讓他們能像其他常規(guī)腎移植受者一樣,能夠及時(shí)的得到腎移植治療并且減少或者避免移植后超急性排斥反應(yīng)的發(fā)生,顯得非常必要。為了更好的解決尿毒癥患者在高致敏狀態(tài)下難以進(jìn)行腎移植的難題,西京醫(yī)院泌尿外科院于2014年3月6日對(duì)一例PRAⅠ類31%、Ⅱ類63%的高致敏尿毒癥受者實(shí)施了腎移植聯(lián)合脾窩異位輔助性肝移植術(shù)。該術(shù)式以保護(hù)移植腎免于發(fā)生超急性排斥反應(yīng)為目的,首次使用腎移植聯(lián)合脾窩異位輔助性肝移植術(shù)來治療高致敏受者。目的:探討腎移植聯(lián)合脾窩異位輔助性肝移植在治療1例高致敏尿毒癥受者中的有效性及安全性方法:我們對(duì)移植受者術(shù)前、術(shù)中以及術(shù)后各個(gè)觀測時(shí)間點(diǎn)的血清進(jìn)行了收集。并通過Luminex檢測技術(shù)檢測了受者體內(nèi)所有預(yù)存抗體變化情況,以此來驗(yàn)證脾窩輔助性移植肝在整個(gè)移植過程中是否對(duì)移植腎同樣具有保護(hù)作用效果。同時(shí),在各個(gè)時(shí)間點(diǎn)收集的血清中檢測DSA以及與供者人類白細(xì)胞抗原(HLA)特異性結(jié)合的C1q抗體(C1q-HLA)的變化情況,以此來觀察腎移植聯(lián)合脾窩輔助性肝移植術(shù)后受體的體液排斥反應(yīng)狀況。結(jié)果:術(shù)后未發(fā)生超急性排異反應(yīng)。術(shù)后第7天預(yù)存抗體水平回升,經(jīng)治療后降低,移植腎功能恢復(fù)正常。在12個(gè)月的隨訪期間:移植物血液灌注及功能狀況良好,預(yù)存抗體、DSA及C1q-HLA抗體水平都逐漸下降。結(jié)論:利用來自同一供體部分肝臟的保護(hù)效應(yīng),腎移植聯(lián)合脾窩異位輔助性肝移植可以有效解決尿毒癥患者在高致敏狀態(tài)下不能進(jìn)行腎移植的問題。
[Abstract]:Background: renal transplantation has become one of the most effective methods in the treatment of end-stage renal diseases.However, some patients who have experienced transplantation, pregnancy, and blood transfusion, the body of the group reactive antibodies preparation is often high and is in the pre-transplant "presensitivity" state.Excessive PRA increased the risk of donor specific antibody DSAs in recipients.The preexisting DSAs in recipients are thought to be the main cause of hyperacute rejection after transplantation.However, once hyperacute rejection occurs, there is no good solution in addition to the removal of the transplanted kidney.Therefore, the detection of PRA is considered as one of the indicators for candidate transplant recipients in many transplant centers.It is very difficult for presensitive recipients to find a well-matched kidney source.In the country, extremely scarce kidney sources are usually transplanted to PRA and DSA negative recipients.This leaves a significant number of presensitized transplant recipients waiting long enough to be treated with continuous dialysis.Therefore, it is very necessary to find a suitable treatment scheme so that they can get kidney transplantation treatment in time and reduce or avoid the occurrence of hyperacute rejection like other normal renal transplant recipients.In order to better solve the problem that uremia patients are difficult to carry out kidney transplantation under the condition of high sensitivity,On March 6, 2014, Urology Department of Xijing Hospital performed renal transplantation combined with splenic fossa heterotopic liver transplantation in a case of PRA class 鈪，

本文編號(hào)：1750923