HLA配型对肾移植长期效果的影响（2508例次总结）  

Effects of HLA matching on long survival of patients with kidney transplantation （report of 2508 cases）

作　　者：薛武军[1] 侯军[1] 田普训[1] 何晓丽[1] 郭奇[1] 丁小明[1] 潘晓鸣[1] 燕航[1] 冯新顺[1] 项和立[1] 李生斌[1] 

机构地区：[1]西安交通大学医学院第一附属医院肾病中心肾移植科器官移植研究所,710061

出　　处：《中华器官移植杂志》2010年第11期654-656,共3页Chinese Journal of Organ Transplantation

摘　　要：目的 探讨HLA配型对肾移植受者术后近期和远期效果的影响.方法 根据肾移植术前HLA配型结果,将2508例次肾移植受者分为7组（即：0、1、2、3、4、5、6个抗原错配组）.观察HLA配型对受者术后急性排斥反应发生率以及移植肾1、5、10年存活率的影响.结果 2508例次进行了HLA-A、B、DR抗原配型的肾移植中,0个抗原错配仅有7例,2～3个抗原错配占74%.0个抗原错配组急性排斥反应发生率为5%,显著低于其他各组（P＜0.01）;而6个抗原全部错配组急性排斥反应发生率为23%,显著高于其他各组（P＜0.01）.0个抗原错配组移植肾1、5、10年存活率分别为97%、90%和88%;1个抗原错配组分别为94%、86%和83%;2个抗原错配组为94%、84%和82%;3个抗原错配组为93%、85%和81%;4个抗原错配组为91%、82%和74%;5个抗原错配组为90%、81%和72%;6个抗原错配组为88%、80%和70%.结论 良好的HLA配型可以降低肾移植急性排斥反应发生率;HLA抗原错配越少,移植肾的长期存活率越高;移植前供、受者HLA配型以抗原错配数≤3个为宜,尽量避免6个抗原全部错配.Objective To investigate the effects of HLA matching on long survival of patients with kidney transplantation. Methods In 2508 cases of renal transplants, based on Ag M standard, in 0 MM-6 MM （7 groups）, the effects of HLA matching on the survival rate of 1 year, 5 years and 10 years, and the incidence of renal acute rejection （AR） in renal allografts were analyzed. Results Only 7 cases had 0-missmatches, and most cases had 2 or 3 missmatches. In the group of zero antigen mismatches, the incidence of renal AR was 5 %, lower than other groups （P〈0. 01）; in the group of six antigen mismatches, the incidence of AR was 23 %, obviously higher than other groups （P〈0. 01）. The 1-year, 5-year and 10-year survival rate was 97 %, 90 %, 88 % in the group of zero antigen mismatches; 94 %, 86 %, 83 % in the group of one antigen mismatches; 94 %, 84 %, 82 % in the group of two antigen mismatches; 93 %,85 %, 81% in the group of three antigen mismatches; 91%, 82 %, 74 % in the group of four antigen mismatches; 90 %, 81%, 72 % in the group of five antigen mismatches; 88 %, 80 %, 70 % in the group of six antigen mismatches. Conclusion Good HLA matching can significantly reduce the incidence of AR of renal allografts and increase the survival rate. If recipients are offered to choose those with HLA antigen mismatches ≤3, it is good for the effective use of donor kidneys, the prevention of rejection, and the improvement of the transplantation results.

关 键 词：肾移植 人白细胞抗原 存活率 急性排斥反应 

分 类 号：R686[医药卫生—骨科学]