摘要
目的：探讨人类白细胞抗原（HLA）配型和抗HLA抗体检测在亲属活体肾移植的应用，及其与移植效果的关系。方法：移植受者及其亲属供体采用PCR—SSP进行HLA配型，移植术前行补体依赖微量细胞毒性试验（CDC）交叉配型，同时采用酶联免疫吸附（ELISA）方法筛查和监测受者的群体反应性抗体（PRA）。分析亲属活体供肾移植的临床效果。结果：够例受者接受了亲属活体供肾移植手术。63例术前抗HLA抗体检测为阴性，其中供受者HLA配型错配（MM）者0-3MM受者57例，3例（5．26％）发生肾功能延迟恢复（DGF），2例（3．51％）发生急性排斥（AR）；HLA4～6MM受者6例中分别有1例（16．67％）和2例（33．33％）发生DGF和AR。HLA0～3MM组AR发生率显著性低于4～6MM组（P〈0．05）。而不同临床免疫抑制方案组之间AR发生率无显著性统计学差异（P〉0．05）。甲基泼尼松龙（MP）和抗人胸腺细胞球蛋白（ATG）冲击等治疗措施后，所有AR得以逆转。3例术前预致敏（PRA35％～87．5％）的受者，HLA2～3MM。1例致敏受者肾功能顺利恢复，PRA维持不变。另2例致敏受者术前自然或经血浆置换后PRA转阴，术后发生AR，ATG冲击治疗后肾功能也恢复正常，抗体有轻度反弹。结论：亲属活体供肾移植的组织配型良好，配合抗HLA抗体监测，使得受者移植的机会增加，排斥反应发生率低，但错配者多，术前致敏受者排斥反应发生率高，应加强围手术期处理。
Objective：To investigate the application of human leukocyte antigen （HLA） matching and anti-HLA antibodies detection in the related- living kidney transplantation, and the relationship between HLA matching, antibodies detection and the outcomes of transplantation. Methodology： Sixty-six patients who had received related-living kidney transplantation were enrolled in this study. Their HLA were typed and matched by polymerase chain reaction-sequence specific primer （PCR-SSP）. The complement-dependent cytotoxicity （CDC） cross-match was used between recipients and living-related donors pre-transplantation. The serum panel reactive antibodies （PRA） of recipients were screened and moni- tored with enzyme-linked immune absorbent （ELISA） assay. The clinical outcomes of related-living kidney transplantation were also analyzed. Results： Sixty-three cases were detected PRA negative pre-transplantation. In 57 cases with 0 - 3 HLA mismatch （ MM ）, 3 （5.26%） developed delayed graft function （DGF） and 2 （ 3. 51% ） had acute rejection （AR）. In 6 cases with HLA 4 -6 MM, 1 （ 16. 7% ） developed DGF and 2 （33. 3% ） had AR, respectively. The incidence of AR in HLA 0-3MM cases was significantly lower than that in HLA 4 -6 MM （P 〈0. 05）, while there was no significant difference in the incidence of DGF. There was no significant difference in the cases with different clinical immunosuppres- sive therapy （P 〉0. 05 ）. All of cases occurred AR were reversed by methylpredisone （MP） pulse therapy and anti-thymus globulin （ATG） treatments. 3 pre-sensitized recipients （ PRA 35% -87. 5% ）, HLA 2 -3MM, were monitored by PRA detection to observe the dynamic variety of anti-HLA antibodies. One recovered as expected with PRA was no change with normal renal function. The others changed to PRA negative naturally or by plasmapheresis pre-transplantation, and developed AR post-transplantation, but returned normal kidney function after ATG treatment. Their antibodies were recu
出处
《肾脏病与透析肾移植杂志》
CAS
CSCD
2008年第1期9-13,共5页
Chinese Journal of Nephrology,Dialysis & Transplantation
