关键词: 急性排异反应, 肾移植, 免疫抑制, 甲强龙, 冲击疗法

Abstract:

BACKGROUND: After the allogeneic kidney transplant operation, acute rejection is one of the most important reasons of transplant kidney hypofunction and eventually defunctionalization. So effective prevention, early diagnosis and acute rejection therapy are important things which relate closely to how long the patient can live.
OBJECTIVE: To summarize the experience of application of immunosuppressive on patients with acute rejection in one month after kidney transplantation.
METHODS: A total of 12 kidney transplantation patients were selected, who are all the first time to do the transplant. After the kidney transplantation, using mycophenolate mofetil capsules, cyclosporine A and methylprednisolone as triple regimen to prevent rejection. During 3 to 30 days after operations, the 12 patients had different clinical manifestation, such as hypourocrinia, kidney transplanted area swollen, serum creatinine increase, urine protein increase, instituted as acute rejection after renal transplantation. First, the patients were treated with methylprednisolone pulse therapy: 5mg/d (d1-3), intravenous drip. Then, taking it orally instead, 24 mg/d, decreasing by 4 mg every 5-7 d, until 8 mg/d.
RESULTS AND CONCLUSION: 12 cases reversed successfully, including 6 cases which reversed by methylprednisolone. Those unable to reverse were treated with Antithymocyte Globulin (ATG) or CD3. In 1 of 4 cases with ATG, urinary output increased rapidly within 8 hours, 2 cases within 24 hours and 1 case within 72 hours. One case with CD3, patient’s urinary output rose quickly within 48 hours. One case used tacrolimus instead of cyclosporine A, at the same time took mycophenolate mofetil capsules and methylprednisolone. After the above treatments, kidney function in all 12 cases recovered gradually. The results suggested that, for patients with acute rejection after kidney transplantation, early detection, diagnosis and timely therapy is the key to reversal successfully.