摘要
目的 探讨术前群体反应性抗体(PRA)水平对等待肾移植患者接受肾移植的比例和术后长期疗效的影响.方法 收集中山大学附属第一医院1998 年1 月到2012 年6 月等待肾移植的7 123 例尿毒症患者资料,根据术前PRA 水平的不同分为5 组:A 组6 124 例,PRA 阴性;B 组160 例,PRA ＜10%;C 组261 例,PRA 10%～29%;D 组374 例,PRA 30%～80%;E 组204 例,PRA ＞80%.比较5 组患者接受肾移植的比例,5 组患者中接受肾移植者的术前人类白细胞抗原(HLA)错配情况,术后患者和移植肾存活率,术后1 年估算肾小球滤过率(eGFR)情况,以及术后移植肾功能恢复延迟(DGF)、急性排斥、慢性排斥和感染等并发症的发生率.结果 A 组患者接受肾移植的比例为31.9%;随着PRA 水平升高,患者接受肾移植比例显著下降,E 组接受肾移植比例最低,为7.3%(P＜0.05).在接受肾移植的患者中,随着PRA水平升高,HLA 错配数显著降低.A 组和B 组术后急性排斥和慢性排斥发生率均显著低于E 组(均P＜0.05),各组DGF 和感染发生率差异无统计学意义(均P＞0.05).A 组的移植肾存活率优于E 组(1 年96.4%比89.5%,5 年76.8% 比63.4%,10 年59.7% 比47.3%,均P＜0.05),术后1 年eGFR 水平也优于E 组(66.7 mL/min 比45.3 mL/min,P＜0.05),但各组患者存活率差异无统计学意义(均P＞0.05).结论 术前PRA 水平越高,肾移植接受率越低,术后发生急性排斥和慢性排斥的风险越高,移植肾的长期预后也越差.
Objective To explore the influence of preoperative panel reactive antibody( PRA) levels on kidney transplantation rate and long-term outcome after transplantation. Methods Clinical data of 7123 cases of uremia patients in the First Affiliated Hospital of Sun Yat-sen University were collected between January 1998 and June 2012. According to the preoperative PRA levels, the patients were divided into five groups. Group A 6124 cases, PRA negative. Group B 160 cases, PRA <10 %. Group C 261 cases, PRA 10 %29 %. Group D 374 cases, PRA 30 %80 %. Group E 204 cases, PRA >80 %. The kidney transplantation rate was compared among these five groups, and the human leukocyte antigen( HLA) mismatched, patients and grafts survival, estimated glomerular filtration rate(eGFR)levels1year after transplantation,and incidences of complications after operation,such as delayed graft function(DGF),acute rejection,chronic rejection and infection were also compared.ResultsThe kidney transplantation rate in group A was31.9%. The kidney transplantation rate reduced significantly with the elevation of PRA levels,while in group E was7.3%(P<0.05). The HLA mismatched loci decreased significantly with the elevation of PRA levels. The incidences of acute rejection and chronic rejection were significantly lower in group A and B compared to group E(allP<0.05). There were no differences in DGF and infection among the groups(allP>0.05). The long-term graft survival(1year:96.4% vs.89.5%,5years:76.8% vs.63.4%, 10years:59.7% vs.47.3%,allP<0.05)and1-year eGFR level(66.7mL/min vs.45.3mL/min,P<0.05)were better in group A compared to group E. However,there was no difference in patient's survival among the groups(all P>0.05).ConclusionWith the elevation of preoperative PRA levels,the kidney transplantation rate decrease, the risk of acute rejection and chronic rejection increase,and the long-term outcomes of kidney grafts become worse.
出处
《实用器官移植电子杂志》
2013年第4期235-239,共5页
Practical Journal of Organ Transplantation(Electronic Version)
基金
中山大学临床医学研究5010计划(2007003)
关键词
群体反应性抗体
肾移植
接受率
长期疗效
Panel reactive antibody
Kidney transplantation
Operation rate
Long-term outcome
