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目的 进一步探讨移植肾超急性排斥（ Ｈ Ａ Ｒ） 的病理学发生机制及临床对策。方法 １９７８ 年６ 月至１９９８ 年２ 月共行同种异体肾移植１５２４／１６０４ 例次，６４ 例发生 Ｈ Ａ Ｒ，对其中６３ 例切除的移植肾标本分别从皮质、髓质及血管取材，行光镜和电镜观察。结果 早期肾间质小血管及肾小球毛细血管内大量红细胞淤滞为主要改变。随着排斥反应的进展，中性粒细胞在肾小球毛细血管腔内聚集，可见毛细血管腔内微血栓形成，并形成梗死灶。肾间质的改变主要为高度水肿，严重的伴间质出血。治疗结果：２１ 例术中即切除移植肾，４２ 例于术后第１ ～２０ 天切肾，仅１ 例移植肾逐渐萎缩未予摘除。首次肾移植失败原因为超急性排斥２６ 例，其中１５ 例经严格配型、血浆置换及 Ａ Ｔ Ｇ 治疗，在１～１７ 天内行再次移植，１０ 例成功。另外１１ 例在术后６ 个月～２ 年后再行二次移植，仅４ 例获得成功（３６ ．３６ ％ ） 。结论 红细胞参加了移植肾的超急性排斥反应。反复输血；多次妊娠；再次移植；服用过人参、西洋参、中药及各种营养剂是 Ｈ Ａ Ｒ 发生的影响因素。
Objective To investigate the pathological mechanism and clinical strategy of hyperacute rejection (H A R) in renal allograft. Methods From June 1978 to February 1998, 1524/1604 renal allografts were performed and 64 cases of H A R were performed. Sixty-three of them were excised from cortex, medulla and blood vessels respectively. Light and electron microscopy. Results The early renal interstitial small blood vessels and glomerular capillary mass red blood cell stasis as the main change. As rejection progresses, neutrophils accumulate in the glomerular capillary lumen, showing microvascular thrombosis in the capillary lumen and the formation of infarcts. Renal interstitial changes mainly due to a high degree of edema, severe interstitial bleeding. Treatment results: 21 cases of intraoperative resection of the kidney graft, 42 cases of postoperative 1 to 20 days of kidney, only 1 case of graft atrophy was not removed. The cause of the first renal transplant failure was hyperacute rejection in 26 cases, of which 15 cases were treated by strict matching, plasmapheresis and ATS treatment. Transplantation was performed within 1 to 17 days and 10 cases were successful. The other 11 cases were transplanted from 6 months to 2 years after operation, and only 4 cases were successful (36.36%). Conclusion Erythrocytes participate in hyperacute rejection of transplanted kidneys. Repeated transfusions; multiple pregnancies; re-transplantation; taking ginseng, American ginseng, Chinese medicine and various nutrients are the influencing factors of H A R.