致敏受者移植肾存活率和抗HLA抗体的临床观察  

Posttransplant renal allograft survival and alteration of anti-HLA antibodies in sensitization recipients

作　　者：傅茜[1] 王长希[1] 曾文涛[1] 费继光[1] 邓素雄[1] 邱江[1] 李军[1] 陈立中[1] 

机构地区：[1]中山大学附属第一医院器官移植中心,广州510080

出　　处：《中华移植杂志（电子版）》2011年第3期17-20,共4页Chinese Journal of Transplantation(Electronic Edition)

摘　　要：目的观察致敏受者与非致敏受者移植肾存活率的差别,以及移植肾功能与抗HLA抗体变化的关系。方法纳入中山大学附属第一医院器官移植中心2000年4月至2008年12月间行肾移植后资料完整受者1309例。根据受者术前ELISA检测群体反应性抗体(PRA)的结果将受者分为50%≤PRA≤100%组(n=35)、10%≤PRA<50%组(n=47)和PRA<10%组(n=1227)。所有供受者采用PCR序列特异性引物进行HLA分型。运用标准HLA配型和氨基酸残基配型。采用Kaplan-Meier法对3组受者术后存活率进行组间生存分析。分析肾移植后抗HLA抗体的变化及其与移植肾功能和HLA错配的关系。结果随着随访时间增加,3组移植肾累积存活率均有下降。在术后3年内3组移植肾存活率差异较小(P>0.05),3年后3组移植肾存活率差异有统计学意义(P<0.05)。10%≤PRA≤100%受者移植肾累积存活率显著低于PRA<10%受者(P<0.05),50%≤PRA≤100%受者移植肾累积存活率也显著低于10%≤PRA<50%受者(P<0.05)。12例移植肾失功的受者中7例(58.3%)出现抗体增强,62例移植肾功能正常的受者中仅8例(12.9%)出现抗体增强,两者差异有统计学意义(P<0.05)。出现新生抗体的受者抗体谱中,大多数包含有针对错配抗原的抗HLA抗体。结论无论是供者特异性还是非供者特异性抗体,抗HLA抗体的存在及其效价都会影响移植肾的存活。术后抗HLA抗体的变化与移植肾功能有关。Objective To investigate the difference in renal allograft survival between sensitized and unsensitized recipients,and to discuss the relevance between allograft function and alteration of anti-HLA antibodies.Methods The patients received renal transplantations at our organ transplant center between April 2000 and December 2008 were included.Renal transplant recipients＇ sera were preoperatively tested by ELISA for panel reactive antibodies（PRA）.A total of 1309 recipients who were followed up were divided into 3 groups：（1） 50%≤PRA（＋）≤100%（n=36）,（2） 10%≤PRA（＋）50%（n=46）,and（3）PRA（-）10%（n=1227）.HLA of all donors and recipients were typed by PCR-sequence specific primer.HLA standard-matching and amino acid residue matching were applied to achieve good matching and avoid donor-specific antibodies.The Kaplan-Meier method was used to evaluate the allograft survival of the 3 groups.Alteration of anti-HLA antibodies and their effect on renal allograft function and the relationship with HLA mismatch were analyzed.Results With the increase in follow-up time,graft survival rates of the 3 groups were decreased.The graft survival rates of the 3 groups were similar in the first 3-year follow-up period（P0.05）,but they had a significant difference in cumulative survivals after 3 years posttransplantation（P0.05）.Better outcome was observed in recipients with 10%≤PRA（＋）50% than in recipients with 50%≤PRA（＋）≤100%.The change of anti-HLA antibodies included stable,increased,and decreased or even disappeared.Of 12 cases of renal dysfunction,antibodies of 7（58.3%） increased.Of 62 cases of transplant recipients with normal renal function,antibodies of only 8（12.9%） increased.Most of antibody spectrum contained the anti-HLA mismatch loci.Conclusions Presence and strengthen of anti-HLA antibodies are vital factors which influence the survival of allograft,though the antibodies are not donor specific.The alteration of anti-HLA antibodies in sensitization

关 键 词：肾移植 致敏 抗HLA抗体 移植肾存活 非供者特异性抗体 

分 类 号：R699[医药卫生—泌尿科学]