Hyperacute rejection in kidney transplant pathological mechanism and clinical response.docVIP

 PAGE \* MERGEFORMAT 18 Hyperacute rejection in kidney transplant pathological mechanism and clinical response Keywords:: Graft rejection Hyperacute renal transplantation Abstract Objective: To explore the hyperacute rejection of renal transplantation (HAR) of the pathological mechanism and clinical response. Methods: A retrospective analysis of 64 cases of HAR patients. The resected specimens of renal transplant morphology and fluorescent antibody staining; and HAR clinical manifestations, treatment outcome and re-surgeries, etc. are summarized. Results: (1) HAR pathological changes: Early renal interstitial small vessels and glomerular capillaries in a large number of red blood cell stasis as the main change, can be found in red blood cell stasis was beaded attached to the vessel wall; (2) Clinical Treatment Results: 21 cases of surgery in the immediate removal of transplanted kidney, 42 cases, respectively, after the first 20 days of cutting a kidney, only 1 patients with symptomatic treatment, the transplanted kidney were not removed gradually shrink. 15 cases of HAR patients by strict matching, plasma exchange and anti-lymphocyte immune globulin (ATG) therapy, in the short term experts re-transplantation, 10 cases of success. 11 cases of HAR patients from 6 months to 2 years later underwent secondary transplantation, only four cases of success. Conclusions: (1) It is speculated that pathological mechanisms: red blood cells may participate in hyperacute rejection; (2) HAR occurred in the impact factors: repeated blood transfusion, multiple pregnancy, re-transplantation, who took ginseng, American ginseng, Chinese medicines and all kinds of Nutrition ; (3) HAR clinical sub-types: can be divided into type Ⅰ (immediate HAR), Ⅱ type (delayed HAR), Ⅲ type (sub-HAR); (4) occurred after HAR in the near future (1 ~ 17 d) re - transplantation is better than the traditional 6 months to 2 years; (5) Countermeasures: emphasis on high-sensitivity group do PRA match