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中华移植杂志(电子版) ›› 2026, Vol. 20 ›› Issue (02) : 96 -103. doi: 10.3877/cma.j.issn.1674-3903.2026.02.005

论著

双重血浆置换和血浆置换对ABO血型不相容亲属活体肾移植受者术前血型抗体的清除效率及远期疗效比较
王琦1, 慕晗梦2, 马艳春2, 王钢1, 李红芹2,()   
  1. 1130000 长春,吉林大学第一医院器官捐献重症监护科
    2130000 长春,吉林大学第一医院泌尿外二科
  • 收稿日期:2025-06-04 出版日期:2026-04-25
  • 通信作者: 李红芹

Comparative study of double filtration plasmapheresis and plasma exchange on preoperative blood group antibody clearance efficiency and long-term therapeutic effect in ABO incompatible living donor kidney transplantation recipients

Qi Wang1, Hanmeng Mu2, Yanchun Ma2, Gang Wang1, Hongqin Li2,()   

  1. 1Department of Organ Donation Intensive Care Unit, the First Hospital of Jilin University, Changchun 130000, China
    2Department of Urology, the First Hospital of Jilin University, Changchun 130000, China
  • Received:2025-06-04 Published:2026-04-25
  • Corresponding author: Hongqin Li
引用本文:

王琦, 慕晗梦, 马艳春, 王钢, 李红芹. 双重血浆置换和血浆置换对ABO血型不相容亲属活体肾移植受者术前血型抗体的清除效率及远期疗效比较[J/OL]. 中华移植杂志(电子版), 2026, 20(02): 96-103.

Qi Wang, Hanmeng Mu, Yanchun Ma, Gang Wang, Hongqin Li. Comparative study of double filtration plasmapheresis and plasma exchange on preoperative blood group antibody clearance efficiency and long-term therapeutic effect in ABO incompatible living donor kidney transplantation recipients[J/OL]. Chinese Journal of Transplantation(Electronic Edition), 2026, 20(02): 96-103.

目的

探讨双重血浆置换(DFPP)和血浆置换(PE)对ABO血型不相容亲属活体肾移植(ABOi-LDKT)受者血型抗体清除效率及远期疗效的影响。

方法

选取2021年3月至2023年9月在吉林大学第一医院器官移植中心行ABOi-LDKT的32例受者为研究对象,根据血库血浆储备量及个人选择治疗方式的不同分为PE组(n=14)和DFPP组(n=18)。分析两组患者血型抗体清除效率,血浆预处理过程中不良反应发生情况,不同时间IgG、IgM血型抗体效价水平、肾功能、凝血功能指标以及急性抗体介导排斥反应(AMR)、感染发生情况等。

结果

PE组和DFPP组分别进行39、51次血浆预处理,移植术后均未发生严重并发症。PE组单次治疗时间短于DFPP组,单次血浆用量高于DFPP组;DFPP组单次血浆预处理量和以体重校正的单次血浆预处理量均优于PE组,差异均有统计学意义(Z=-5.006,t=45.64、-26.16和-9.16,P均<0.05)。两组受者血浆预处理后IgG、IgM效价均显著降低,PE组和DFPP组IgG清除效率分别为0.62±0.14和1.08±0.67,IgM清除效率分别为1.05±0.47和1.23±0.75,差异均无统计学意义(t=-1.872和-0.487,P均>0.05)。PE组与DFPP组血浆预处理过程中发生不良反应的受者比例分别为42.9%(6/14)和44.4%(8/18),差异无统计学意义(P>0.05)。PE组与DFPP组受者血浆预处理前凝血指标差异均无统计意义,移植时各指标差异均有统计学意义(P均<0.05)。两组受者血浆预处理前和移植术后不同时间点血清肌酐和估算肾小球滤过率差异均无统计学意义。随访至移植后12个月,PE组发生2例AMR,DFPP组未发生;发生术后感染的受者比例分别为42.9%(6/14)和33.3%(6/18),差异均无统计学意义(P均>0.05)。

结论

经过DFPP和PE预处理,ABOi-LDKT受者血型抗体效价均显著降低,远期血清肌酐、估算肾小球滤过率等指标明显改善,但DFPP对受者凝血指标影响更显著,需通过补充纤维蛋白原,监测凝血功能确保移植手术安全进行。

Objective

To investigate the effects of double plasma exchange (DFPP) and plasma exchange (PE) on the clearance efficiency of blood group antibodies, and long-term therapeutic outcomes in the recipients of ABO-incompatible living donor kidney transplantation (ABOi-LDKT).

Methods

A retrospective analysis was conducted on clinical data of 14 ABOi-LDKT recipients who underwent sole PE pretreatment and 18 ABOi-kidney transplant recipients who underwent sole DFPP pretreatment at the First Hospital of Jilin University from March 2021 to September 2023. Both groups received regular follow-up for 12 months, and the clearance efficiency of blood group antibodies, incidence of adverse reactions during plasma pretreatment, levels of IgG and IgM blood group antibodies, renal function, coagulation indicators, acute antibody-mediated rejection (AMR), and infection rates were analyzed.

Results

The PE group and DFPP group underwent 39 and 51 plasma pretreatments, respectively, with no severe complications occurring after transplantation. Compared with the DFPP group, the PE group had a shorter single treatment duration but higher single plasma consumption. The DFPP group outperformed the PE group in terms of single plasma pre-processing volume and body weight-corrected single plasma pre-processing volume, with statistically significant differences (Z=-5.006, t=45.64, -26.16, and -9.16, all P<0.05). The titers of IgG and IgM in both groups were markedly reduced after plasma pretreatment, IgG clearance efficiencies of the PE group and the DFPP group were 0.62±0.14 and 1.08±0.67, respectively, and IgM clearance efficiencies were 1.05±0.47 and 1.23±0.75, with no statistically significant differences (all P>0.05). The incidence of adverse reactions in the PE and DFPP groups was 42.9% (6/14) and 44.4% (8/18), respectively (P>0.05). No significant difference in coagulation parameters was observed between the PE and DFPP groups before plasma pretreatment; however, significant differences emerged at transplantation. The levels of serum creatinine and estimated glomerular filtration rate showed no statistically significant differences between the two groups of recipients before plasma pretreatment and at various time points after transplantation. Within 12 months post-transplantation, two cases of AMR occurred in the PE group, while no cases were observed in the DFPP group, and the infection rates in the PE group and DFPP group were 42.9% (6/14) and 33.3% (6/18), respectively (P>0.05).

Conclusions

Both DFPP and PE pre-treatment significantly reduced blood group antibody titers in ABOi-LDKT recipients, with long-term improvements in blood creatinine and glomerular filtration rate. However, the DFPP group exhibited more significant impacts on coagulation indicators. Supplementing fibrinogen and monitoring coagulation function can further ensure the safety of transplantation.

表1 PE组和DFPP组ABOi-LDKT受者一般资料比较
表2 PE组和DFPP组ABOi-LDKT受者血浆预处理情况比较
表3 PE组和DFPP组ABOi-LDKT受者血浆预处理过程中不良反应发生情况比较(例)
图1 PE组和DFPP组ABOi-LDKT受者血浆预处理前后血型抗体效价变化注:PE.血浆置换;DFPP.双重血浆置换;ABOi-LDKT. ABO血型不相容亲属活体肾移植
表4 PE组和DFPP组ABOi-LDKT受者凝血功能指标比较(±s)
表5 PE组和DFPP组ABOi-LDKT受者肾功能指标比较(±s)
表6 PE组和DFPP组ABOi-LDKT受者术后感染发生情况比较(例)
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