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目的 :亲属活体供肾与供外周血造血干细胞的联合移植 ,方法 :采用患者母亲的左肾移植给儿子 ,肾移植后第 5天对供体进行骨髓造血干细胞动员 (G -CSF 5 μg/kg·d× 5d)。受者术后在使用免疫抑制剂 (CsA+Asa +pred)第 7天的基础上进行非完全清除性预处理 ,在受体术后第 10天 ,供体动员的第 5天 ,查供体WBC4 8 8× 10 9/L ,分类中间细胞 (MO) 13 6% ,淋巴细胞 (Lr) 7 5 % ,MO +Lr的绝对值已达到 10 3× 10 9/L。于采集干细胞前 1 5h再动员一次 ,然后用血细胞单采分离机采集外周血造血干细胞。结果 :采集单个核细胞 (MNC)60g ,幼稚细胞间接计数为 2 1× 10 8·kg-1,采集后 2h内输注受体内。移植后 2天受体肾功能恢复正常 ,血常规、肝功能检测均在正常范围内。肾移植术后第 2 5天出院。随访 1年 ,患者身体状况良好 ,移植肾功能正常。免疫抑制剂小剂量维持治疗 ,效果良好。患者未出现感染、移植抗宿主病、出血性膀胱炎、移植排斥反应等。结论 :通过亲属异基因外周血造血干细胞与活体供肾联合移植术 ,可以使植入的造血干细胞与宿主细胞形成混合性嵌合体 ,起到免疫耐受的作用。可能会延长移植肾的存活时间。
OBJECTIVE: Co-transplantation of living donor kidneys and peripheral blood hematopoietic stem cells. METHODS: The left kidney of a patient’s mother was transplanted to his son. On the 5th day after kidney transplantation, the donor was mobilized by bone marrow hematopoietic stem cells (G-CSF 5 μg / kg · D × 5d). The recipients were pretreated on the seventh day with immunosuppressive agents (CsA + Asa + pred) on the 10th postoperative day, the fifth day after the donor was mobilized, and the donor The absolute value of MO + Lr reached 10 3 × 10 9 / L for WBC4 8 8 × 10 9 / L, classification of intermediate cells (MO) 13 6% and lymphocytes (Lr) 75%. Mobilized once 15 h before collecting stem cells, and then collected peripheral blood hematopoietic stem cells with a blood cell apheresis machine. Results: Mononuclear cells (MNC) were collected at a dose of 60 g. The indirect cell count of immature cells was 21.1 × 10 8 kg -1, and the cells were transfused within 2 hours after the acquisition. Two days after transplantation, the renal function of the recipient returned to normal, and the blood tests and liver function tests were within the normal range. 25 days after renal transplantation was discharged. One year follow-up, patients in good condition, normal renal graft function. Immunosuppressive low-dose maintenance treatment, the effect is good. No infection in patients, graft-versus-host disease, hemorrhagic cystitis, transplant rejection and the like. CONCLUSION: Combined transplantation of allogeneic peripheral blood hematopoietic stem cells and living donor kidneys can result in the formation of mixed chimerism of implanted hematopoietic stem cells and host cells, which play an immunological tolerance role. May prolong the survival time of the kidney graft.