PRA、HLA配型技术在肾移植中的应用  

The role of PRA measurement and HLA-antigen matching in renal transplantation

作　　者：于立新[1] 萧露露[2] 付绍杰[1] 白喜文[1] 徐健[1] 马俊杰[1] 叶桂荣[1] 邓文锋[1] 王亦斌[1] 杜传福[1] 刘小友[1] 

机构地区：[1]第一军医大学南方医院,广州510515 [2]广州器官移植配型中心

出　　处：《中华泌尿外科杂志》2000年第5期277-279,共3页Chinese Journal of Urology

摘　　要：目的　探讨群体反应性抗体 (PRA)、HLA配型技术对肾移植近远期效果的影响。　方法　对等待肾移植的 1 0 2 0例患者采用PRA测定、HLA组织配型 ,PRA阴性或阳性者均经血浆置换 ,HLA抗原 3～ 6个位点相合为第一组 ;未采用PRA、HLA组织配型的 42 3例患者为第二组。观察两组肾移植术后免疫指标的变化 ,近期急性排斥反应发生率以及HLA A、B、DR位点对长期存活的影响。　结果　第一组肾移植术后环孢素A(CsA)用量减至 5～ 7mg·kg- 1 ·d- 1 ,移植肾功能恢复时间 2～ 1 6天 ,平均 5天 ,均未发生超急性排斥反应 ,发生急性排斥反应者 1 73例 (1 7.0 % ) ,1年人 /肾存活率高达 98 3 % /96 .0 % ,3年人 /肾存活率 93 .0 % /85 2 % ,5年人 /肾存活率 88.0 % /82 6 %。第二组CsA用量 8～ 1 2mg·kg- 1 ·d- 1 ,移植肾功能恢复时间 4～ 30天 ,平均 1 3天 ,发生超急性排斥反应者 9例 (2 .1 % ) ,急性排斥反应者 1 98例 (47.0 % ) ,1年人 /肾存活率 86 7% /76 3 % ,3年人 /肾存活率72 5 % /67 9% ,5年人 /肾存活率 69 5 % /49 3 %。　结论　PRA阴性、良好HLA配型可防止超急性排斥反应发生 ,并可降低急性排斥反应发生率 ,提高人Objective To evaluate the role of PRA measurement and HLA antigen matching in renal transplantation. Methods PRA measurement and HLA antigen matching have been carried out for 1 020 patients on the waiting list for renal transplantation.These patients have underwent plasma exchange and HLA A,B,DR were well matched no matter PRA being negative or positive.423 patients with neither PRA measurement nor HLA antigen matching served as controls.The patient and graft outcome have been observed. Results In the 1 020 cases studied,the post transplantation CsA dose was 5～7mg·kg -1 ·d -1 and the graft function recovery time 2～16 days with a mean of 5 days.Acute graft rejection occurred in 173 (17.0%) with no hyper acute rejection observed.The 1,3,and 5 year patient/graft survival rates were 98.3%/96.0%,93.0%/85.2% and 88.0%/82.6% respectively.In the controls,CsA dose ranged from 8 to 12mg·kg -1 ·d -1 and the graft function recovery time 4～30 days with a mean of 13 days.Hyperacute rejection occurred in 9 (2.1%) and acute rejection in 198 (47%).The 1,3, and 5 year survival rates (patient/graft) were 86.7%/76.3%,72.5%/67.9% and 69.5%/49.3% respectively. Conclusions Negative PRA and well matched HLA antigen would eliminate the occurrence of hyperacute rejection,lessen the occurrence of acute graft rejection and makes the patient/graft outcome better.

关 键 词：肾移植 移植物排斥 PRA HLA 配型 

分 类 号：R699[医药卫生—泌尿科学]