| Objective:Through the diagnosis and treatment of antibody-mediated rejection after renal transplantation in the transplant center,the curative effect and long-term infection of different diagnosis and treatment schemes of antibody-mediated rejection after renal transplantation were analyzed.Research methods:The data of 82 patients with antibody-mediated rejection in the second Department of Urology of the first Hospital of Jilin University from January2018 to July 2021 were analyzed retrospectively.excluding the patients with follow-up loss and severe T cell-mediated rejection,66 patients who were treated with CNI+ mycophenolic acid plus hormones were divided into three groups:IVIG+ rituximab + plasmapheresis and IVIG,IVIG+ rituximab for data analysis.In addition,4 cases were treated with bortezomib and 3 cases were treated with rituximab alone.Results:12 patients were treated with IVIG+ rituximab plus plasma exchange,13 patients were treated with IVIG,and 41 patients were treated with IVIG+rituximab.From the perspective of creatinine,the curative effect data of the three groups were analyzed and compared,and there was no significant difference in creatinine between the three groups before and after treatment.There was no significant difference between mortality and renal allograft power loss.The curative effects of the three groups before and after creatinine treatment were statistically significant.IVIG+ rituximab with a large sample size was compared with the subgroup within the group.according to the acute and chronic rejection groups,the therapeutic effect of the acute group was significantly different from that of the chronic group.In the comparison of PRA,there were statistical differences in PRA among the three groups before treatment,between groups 3 and 1,and between groups3 and 2.The effect of IVIG+ rituximab II antibody + plasma exchange group before and after PRA treatment was statistically significant.There was no statistical significance in the effect of PRA before and after treatment in the other two groups.Combined with the analysis of creatinine treatment,patients with higher PRA can achieve better therapeutic effect of renal function and decrease of PRA by using IVIG+ rituximab plus plasma exchange.IVIG+ rituximab or IVIG can also achieve better therapeutic results in patients with lower PRA,while reducing treatment consumption and avoiding the risk of plasma exchange.Among the 4 patients treated with bortezomib,1 patient with CAMR treated with IVIG+ twice had symptoms controlled,creatinine remained stable within half a year,the kidney did not fail in half a year,and the transplanted kidney survived for more than one year.In 2 AMR patients treated with IVIG+plasmapheresis plus bortezomib,creatinine remained stable within half a year,and the transplanted kidney survived for more than a year.One patient with AAMR treated with plasmapheresis and bortezomib had renal allograft failure after treatment and underwent resection.All the 3 CAMR patients treated with rituximab had a stable decrease of creatinine for half a year after treatment,and all the transplanted kidneys survived for more than one year.In the one-year infection rate statistics after treatment,the infection rate of IVIG+ rituximab + plasma exchange group and IVIG+ rituximab group was 8%and 0%.It shows that the long-term immunosuppression is controlled in a good degree after treatment.Conclusion:1.When PRA is high,IVIG+ rituximab + plasma exchange regimen can achieve better therapeutic effect on antibody-mediated rejection after renal transplantation.2.When PRA is low,IVIG or IVIG+ rituximab can achieve better therapeutic effect on antibody-mediated rejection after renal transplantation.3.IVIG+ rituximab is more effective in the treatment of acute rejection and chronic rejection.4.The infection rates of IVIG+ rituximab + plasmapheresis group,IVIG+rituximab group and IVIG group were lower one year after treatment. |
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