肾移植交叉反应组配原则临床应用分析

Application of Human Leukocyte Antigen and Cross-reactive Antigen Group Matching in 149 Renal Transplantations.

日的:探讨人类白细胞抗原(HLA)交叉反应组(CREGs)配型原则在临床肾移植中的应用及意义。方法:对传统配型原则Ⅰ类抗原错配(MM)2个以上位点的149例肾移植,采用CREGs配型原则选择供受者,观察其术后一年存活率及术后一月内急性排斤反应发生率情况。结果:在不考虑DR位点的情况下,按CREGs配型原则选择供受者,供受者HLA-Ⅰ类抗原0、1和2MM数分别为36例(24 16％),62例(41 61％)和51例(34 22％);术后一月内急性排斥反应发生率分别为16 67％(6例)、27 40％(16例)和43.14％(22例);术后一年存活率分别为97 22％(35例)、93 55％(58例)和82 35％(42例)。结论:在传统配型不满意的情况下,对HLA-Ⅰ类抗原采用CREGs配型原则选择供受者,可以获得满意的移植肾一年存活率,减少术后排斥反应发生率,为等待供肾的患者提供了更多机遇,问时亦为获得配型良好的供肾提供了机会。

Objective To investigate the application and significance of human leukocyte (HLA) and cross-reactive antigen groups (CREGs) matching in clinical renal transplantation. Methods In all the 149 kidney transplantation ,Class I CREGs matching criteria re placed conventional HLA-A,B matching with more than two A,B mismatches(MM) according conventional HLA matching criteria The survival rate one year after the graft and incidence of acute rejection in one month after the transplantation were obsewed Results The number of 0,1 and 2 MM according CREGs matching- crtiteria disregarding DR locus was 36(16 67%) ,62(41 61%) and 51(34 14%) respectively The survival rat 1 year after the transplant was 97 22%(35)in the patients with 0MM, 93 55%(58)m ones with 1MM and 82 35%(42)m ones with 2MM The percentage of acute rejection was 16 67%(6) ,24 40% (16)and 43 14% (22)respectively There was not statistically significant difference in the survival rate and the incidence of the acute rejection in one month after transplantation disregarding DR between class 1 CREGs OMM and 1MM ( P >0 05) However,Class I CREGs OMM was significantly superior to 2MM group in the survival rate( P<0 05) and the incidence of the acute rejection( P<0 01) Conclusions Under the situation of unsatisfactory conven tional HLA matching, donor selection criteria based on Class I CREGs matching seem to favor recipients. Better survival and less acute re-jection can be achieved By CREGs matching criteria. Moreover, using CREGs matching criteria would significantly increase the prossibthgy of receiving well-matched kidney in the recipients and provide more chance for waiting recipients.