Clinical Application And Curative Effect Analysis Of Lymphoplasmapheresis In Kidney Transplantation Patients

Objective To analyze the clinical application and effectiveness of lymphoplasmapheresis（LPE）in the prevention and treatment of kidney transplantation rejection.MethodsA total of 51 kidney transplant patients admitted to the First Affiliated Hospital of Anhui Medical University from September 2019 to February 2022 were collected.Including35 patients with positive panel reactive antibody（PRA）before surgery,11 patients with blood group antibodies incompatible kidney transplantation,and 5 patients with acute rejection after surgery,the changes of PRA、blood group antibody titer,donor special antibody（DSA）、lymphocyte subsets、blood creatinine and UREA before and after lymphoplasmapheresis were compared in each group.Results35 PRA positive patients underwent 3-7 times LPE,there were 12 cases of negative PRA,and the other 23 cases had significant decline[HLA class Ⅰ:（23.41±8.34）%vs（12.41±1.45）%,t=4.417,P<0.05;HLA class Ⅱ:（31.58±9.13）%vs（15.05±2.48）%,t=7.313,P<0.01;HLA class Ⅰ and Ⅱ: class Ⅰ（36.19±10.35）% vs（16.37±2.17）%,t=8.047,P<0.01,class Ⅱ（21.48±5.46）% vs（8.74±1.58）%,t=6.412,P<0.01].11 patients with blood group antibodies incompatible kidney transplantation underwent 3-5 times LPE,9 patients with ABO blood group incompatibility had blood group antibody titer Ig M and Ig G <1∶16 on the day of operation,1 patient with Rh D blood group incompatibility had Rh anti-D titer < 1:16 on the day of surgery,and the blood group antibody titer of 1 patient did not decrease to the target level[1],gave up the surgery.5 patients with acute rejection underwent 2-5 times LPE,compared with the rejection site,the median fluorescence intensity（MFI）of DSA decreased significantly（4056.00±1747.46 vs 906.01±547.16,t=5.485,P<0.05）,renal function improvement,the CD4+T/CD8+T ratio decreased,and the difference was statistically significant（t=8.852,P<0.05）,the percentage of CD19+B lymphocytes decreased,and the difference was statistically significant（t =7.494,P < 0.05）.ConclusionLPE is effective for PRA positive patients before kidney transplantation,blood group antibody incompatibility patients and acute rejection patients after transplantation.It can adjust the proportion of lymphocyte subsets,the treatment effect is lasting.