中国组织工程研究与临床康复2009，Vol.13Issue(44)：8623-8627,5.DOI:10.3969/j.issn.1673-8225.2009.44.004
人类白细胞抗原配型及其抗体监测在亲属活体供肾移植中的应用
Human leukocyte antigen matching and Anti-HLA antibody monitoring in living related kidney transplantation
曾文涛 1傅茜 1刘龙山 1王长希2
作者信息
- 1. 中山大学附属第一医院外科实验中心,广东省广州市,510080
- 2. 中山大学附属第一医院器官移植中心,广东省广州市,510080
- 折叠
摘要
Abstract
BACKGROUND:Human leukocyte antigen(HLA)is an important impact factor of kidney transplant outcome.Preoperative anti-HLA antibody detection attributes to screen out presensitized patients.OBJECTIVE:To demonstrate the effect of HLA matching combined with anti-HLA antibody detection in living donor kidney transplantation(LDKT).DESIGN,TIME AND SETTING:A single sample observation and retrospective analysis was performed at the First Affiliated Hospital of Sun Yat-Sen University between February 2004 and September 2007.PARTICIPANTS:Totally 66 patients underwent living related kidney transplantation was selected,including 27 male and 39 female donors,aged 19-66 years,and 50 male and 16 female recipients.METHODS:HLA antigens including A,B and DR genotypes were determined by polymerase chain reaction-sequence specific primer.Complement-dependent cytotoxicity(CDC)was preoperatively applied to do cross-match between the donor and recipient.Methylprednisolone plus anti-CD25 monoclonal antibody or antithymocyte globulin was utilized for immunity induction therapy intraoperative as well as early stage after operation.The triple therapy regimens of ciclosporin A/Tacrolimus combined with mycophenolate and prednisone was utilized for maintenance immunosuppressive therapy.MAIN OUTCOME MEASURES:Panel reactive antibody(PRA)in recipients was monitored by enzyme-linked immune absorbent(ELISA)assay,transplant outcome and the acute rejection status of patients underwent different immunosuppression agent were analyzed.RESULTS:In 66 living kidney transplant recipients,60 recipients were HLA mismatched at 0-3 MM and 6 HLA mismatched at 4-6 MM.In the 60 patients with 0-3 MM,3 developed delayed graft function(DGF,5%)and 4 developed acute rejection(AR,7%).In the 6 patients with 4-6 MM,1 developed DGF(17%)and 2 developed AR(33%)respectively.The incidence of DGF and AR was significantly different between 0-3 MM group and 4-6 MM group(P＜0.05).In addition,different immunosuppression agent had no significant effect on DGF and AR(P＞0.05).All AR patients were reversed after pulse therapy of methylpredisone and anti-thymus globulin.Three presensitized patients were dynamically monitored to determine PRA level.One of them presented stable PRA level with stable graft function.Although another two patients preoperativeiy turned into PRA negative naturally or after plasmapheresis therapy,AR occurred after transplantation due to PRA rebound.CONCLUSION:HLA matching has close correlation with DGF and AR in living-related kidney transplantation.Preoperatively HLA matching and anti-HLA antibody monitoring are important for living related kidney transplant,especially for presensitized recipients.关键词
亲属活体肾移植/人类白细胞抗原/抗人类白细胞抗原抗体引用本文复制引用
曾文涛,傅茜,刘龙山,王长希..人类白细胞抗原配型及其抗体监测在亲属活体供肾移植中的应用[J].中国组织工程研究与临床康复,2009,13(44):8623-8627,5.
