猪同种异体肾移植术前组织配型方法探讨

An Exploratory Study of Preoperative Analysis on Histocompatibility in Porcine Allo-kidney Transplantation

同种异体器官移植及建立器官移植模型术前进行严格组织配型有利于减少免疫学因素的影响,使受体和移植物长期存活。由于目前没有成熟的猪组织配型方法及试剂,我们模拟人器官移植方法选择供受体建立猪同种异体肾移植模型。从23头四川白猪中选择ABO血型相同、ABO血交叉配血反应阴性、微量淋巴细胞毒反应(CDC)、阴性单向混合淋巴反应(MLR)相对较低的同胞猪共6对(1例只作供体)为供受体行单肾原位移植,另一侧肾切除。5例组织相容性较低(MLR在2175～3560之间,CDC计分在1～4分之间),其中2例于术后第2d死于手术打击,2例术后第4d分别死于急性肾小管坏死和加速性排斥反应,1例术后1周死于急性肾小管坏死。6例组织相容性较高(MLR在982～1916之间,CDC计分在2～4分),其中1例死于手术麻醉,3例分别于术后2周死于加速排斥和急性排斥,1例术后肾功能良好,另1例术后发生轻微排斥反应,而后肾功能恢复正常。提示模拟人组织配型方法选择供受体可以建立猪同种异体肾移植模型。通过ABO血型、交叉配血、CDC及MLR实验筛选成功地避免了超急性排斥反应的发生。但从本实验数据中很难分析该配型方案在避免加速型排斥反应、急性排斥反应和慢性排斥的作用,进一步的实验仍在研究之中。

Human tissue typing methods were employed in developing a porcine allotransplantation model. 23 Chinese Sichuan White Pigs（2-3 months old, 17.5-4.6kg, with clear family background） were selected for tissue typing, ABO blood type cross reaction, complement-dependent cytotoxicity （CDC） cross reaction and one way mixed lymphocyte reaction （MLR）. 6 pairs of swine that showed better matching results were selected as donors and recipients. Single-kidney orthotopic transplantation was conducted after removing both kidneys of the recipient. Five recipients showed low matching results （MLR ranging from 2175 to 3560, CDC from 1 to 4）; of them, 2 died of operation, 2 died of acute renal tubular necrosis and accelerating rejection 4 days after operation respectively, and 1 died of acute renal tubular necrosis 4 days after operation. 6 recipients showed high matching results （MLR ranging from 982 to 1916, CDC from 2 to 4）; of them, 1 died of anaesthesia during operation, 3 died of accelerating rejection and acute rejection 2 weeks after operation respectively, 1 had good kidney function, and 1 presented weak rejection 1 week after operation but the kidney function came back to normal afterwards. Human tissue typing methods could be adopted in developing the porcine model. Hyperacute rejection could be avoided by screening ABO blood type, CDC and MLR tests. However, based on these primary data, it was hard to evaluate the predictive values of CDC and one-way MLR for accelerating rejection, acute rejection and graft chronic dysfunction. Further research by expanding experiments in these aspects is still going on.