Analysis of the effect of plasma exchange on improving delayed graft function after kidney transplantation
10.3760/cma.j.cn114452-20240904-00489
- VernacularTitle:血浆置换改善移植肾功能恢复延迟的效果分析
- Author:
Xue LIU
1
;
Shuya WANG
1
;
Qiankun YANG
1
Author Information
1. 郑州大学第一附属医院输血科，郑州 450052
- Publication Type:Journal Article
- Keywords:
Plasma exchange;
Delayed graft function;
Serum creatinine;
Post-transplant rejection
- From:
Chinese Journal of Laboratory Medicine
2025;48(7):924-929
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the effect of plasma exchange (PE) in improving renal function among patients with delayed graft function (DGF)following kidney transplantation.Methods:This was a retrospective cohort study. Data were collected from 76 patients who underwent their first-time ABO-compatible kidney transplantation at the Kidney Transplantation Center of the First Affiliated Hospital of Zhengzhou University between January 1, 2022, and November 30, 2023, and subsequently developed DGF and received PE treatment. The cohort included 39 males and 37 females, with a median age of 37.5 years (30.8-46.0 years). Patients were categorized into three groups based on pre-PEhuman leukocyte antigen (HLA) antibody status: HLA antibody-negative group, HLA antibody-unknown group, and HLA antibody-positive group. Additionally, immunological status prior to PE categorized patients into four groups: (1) stable lymphocyte subsetand antibody profiles (21 cases); (2) elevated B cell proportions or antibody production, or increased antibody titers (26 cases); (3) increased proportions of T/NK/macrophages (13 cases); (4) increased proportions of T/NK/macrophages combined with antibody production or increased antibody titers (16 cases). The Wilcoxon rank-sum test was used to analyze changes in serum creatinine (Scr) levels and 24-hour urine output before and after PE in the different patient groups.Results:In the HLA antibody-negative group, Scr decreased significantly from 467 (260, 571) μmol/L before PE to 176 (123, 307) μmol/L after PE ( Z=-2.22, P<0.01), and 24-hour urine output increased significantly from 1 295 (480, 2 020) ml to 1 960 (1 632, 2 870) ml ( Z=1.76, P<0.01). In the HLA antibody-positive group, Scr decreased significantly from 420 (254, 660) μmol/L before PE to 177 (151, 287) μmol/L after PE ( Z=-3.26, P<0.01), and 24-hour urine output increased significantly from 1 355 (928, 1 925) ml to 2 440 (1 760, 2 797) ml ( Z=2.47, P<0.01). For patients grouped by immunological status, Scr levels in Group 2 decreased significantly from 407 (242, 699) μmol/L to 201 (157, 274) μmol/L ( Z=-2.92, P<0.001), while in Group 3, Scr decreased significantly from 330 (258, 594) μmol/L to 164 (152, 280) μmol/L ( Z=-1.97, P=0.017). Regarding 24-hour urine output, Group 2 showed a significant increase from 1 353 (850, 1 770) ml to 1 995 (1 740, 2 630) ml ( Z=3.43, P=0.003), while in Group 3, urine output increased from 1 850 (1 350, 2 480) ml to 2 200 (1 900, 2 850) ml, but the difference was not statistically significant ( Z=1.10, P>0.05). Conclusion:PE effectively reduces Scr levels and increase 24-hour urine output in patients with DGF after kidney transplantation, regardless of pre-treatment HLA antibody status. Additionally, for patients with post-transplant changes primarily in T/NK/macrophages without significant antibody changes, PE can also effectively reduce Scr levels.
