Abstract:

Objective To summarize the experience in the treatment of antibody mediated rejection（AMR）after kidney transplantation. Methods A retrospective analysis was conducted on kidney transplant recipients who was diagnosed as AMR by biopsy in the Third Medical Center of the General Hospital of the People's Liberation Army from 2018 to 2021. Regular follow-up and prognosis were analyzed after treatment. The survival time of the graft between different time of rejection after transplantation，pathological type，DSA type，and number of kidney transplants were compared，and factors that may affect prognosis were preliminarily screened. Results The results showed that 14 recipients were diagnosed with AMR. After combination therapy of plasma exchange，lymphocyte depleting antibody and immunoglobulin treatment，the overall 1-year graft survival rate was 78.6%，and the 5-year survival rate was 43%. Within 6 months after treatment，3 cases with infection required hospitalization，including 1 case of cutaneous herpes zoster infection，1 case of urinary tract infection，and 1 case of diarrhea. There were nolife-threatening or graft loss case directly related to infection. Conclusion A combination treatment based on plasma exchange can achieve some effects in the treatment of antibody mediated rejection after kidney transplantation. Further research is needed on the optimization of protocols for different types of rejection. 

Key words:

">  , Kidney transplantation, Antibody mediated rejection, Rituximab, Plasma exchange

摘要：

目的 总结肾移植术后抗体介导的排斥反应（antibody mediated rejection，AMR）治疗经验。方法 回顾性分析 2018 — 2021 年解放军总医院第三医学中心行肾移植术后经活检诊断为 AMR 的受者，治疗后规律随访并分析预后，对比移植后排斥反应发生的时间、病理类型、DSA 种类、受者肾移植次数不同情况下，移植物的存活时间，初步筛选可能影响预后的因素。 结果 14 例受者诊断为 AMR，经过血浆置换、淋巴细胞清除性抗体及免疫球蛋白联合治疗，随访总体 1 年移植物生存率为 78.6%，5 年生存率为 43%。治疗后 6 个月内出现需要入院治疗的感染 3 例，其中皮肤带状疱疹感染 1 例，尿路感染 1 例，腹泻 1 例。未出现与治疗直接相关的危及生命的感染。 结论 血浆置换为基础的联合方案治疗肾移植后抗体介导的排斥反应可取得一定的效果。针对不同类型排斥反应的优化方案尚需进一步研究。

关键词:

肾移植 , 抗体介导排斥反应 , 利妥昔单抗 , 血浆置换