Abstract:

Objective To investigate diagnostic methods and principles of treatment of acute antibodymediated rejection （AAMR） after kidney transplantation. Methods To analyze the clinical diagnosis and treatment of AAMR in 4 cases of renal transplantation Results Two patients with panel reaction antibody（PRA） positive and 2 patients with PRA negative before transplantation received kidney transplantation，3 patients received kidneys from donors after citizen's death（DCD） and 1 patient from his mother， PRA level， donor special antibody（DSA） and pathology of biopsy of transplanted kidneys were diagnosed as AAMR，2 cases of renal function returned to normal, while others failed to escape from hemodialysis after treatment of AAMR including plasmapheresis， bortezomib for injection， intravenous immunogloblin. Conclusion Renal transplantation after AAMR rejection is one of the leading causes of transplanted renal dysfunction, early diagnosis and treatment is the key to improve the prognosis.

摘要：

目的 通过分析病例探讨肾移植术后急性抗体介导的排斥反应（acute antibody-mediated rejection，AAMR）诊断方法和处理原则。方法 分析 4 例肾移植术后 AAMR 的临床诊断和治疗过程。 结果 2 例为术前群体反应性抗体（panel reactive antibody，PRA）阳性，2 例为 PRA 阴性患者，其中 3 例为 公民逝世后器官捐献（donation after citizen's death）来源供体，1 例为亲属母亲供肾。术后出现尿少，血肌酐 升高，经检测 PRA、供体特异性抗体（donor special antibody，DSA）和移植肾穿刺活检联合诊断为 AAMR， 经过应用硼替佐米、血浆置换、输注静脉注射免疫球蛋白（intravenous immunoglobulin，IVIG）治疗后，其中 2 例患者移植肾功能恢复正常，2 例未能脱离血液透析治疗。结论 肾移植术后 AAMR 是导致移植肾功能 丧失的主要原因之一，早期诊断和处理是改善预后的关键。