致敏受者肾移植急性排斥反应的影响因素

Risk factors of acute rejection in sensitized kidney transplant recipients

目的探讨致敏受者肾移植急性排斥反应的影响因素。方法对102例术前致敏患者临床资料进行回顾性分析,探讨群体反应抗体(PRA)水平、氨基酸残基配型、术后PRA水平升高及细胞因子基因型对急性排斥反应发生率的影响。结果和结论102例致敏肾移植受者术后随访期间发生急性排斥反应33例次,其中PRA水平、氨基酸残基相配程度、术后PRA水平升高、TNF-α高产量基因型和IL-10高产量基因型对移植肾的急性排斥发生率均有显著性影响。术前综合评估这些因素,有利于制订合理的免疫抑制方案。

Objective To identify the risk factors of acute rejection in sensitized recipients undergoing kidney transplantation. Methods The clinical data of 102 sensitized kidney transplant recipients were retrospectively analyzed to evaluate the incidence of acute rejection in relation to panel reactive antibodies (PRA), amino acid residual match, postoperative elevation of PRA level and cytokine genotypes. Results During the follow-up, acute rejection occurred in totally 33 patients, and the incidence was higher in the recipients with high tumor necrosis factor (TNF)-α or high interleukin (IL)-10 producer genotype than in those with low TNF-α or low/intermediate IL-10 producer genotype (53.1%, 55.0% vs 22.8%, 20.9%, P<0.01 respectively). Acute rejection was even more frequent in the recipients with both high TNF-α and high/intermediate IL-10 producer genotypes than in those with low TNF-α and IL-10 producer genotype (66.7% vs 10.2%, P<0.01). No relations were found between TGF-β1, IL-6, IFN-γ gene polymorphisms and the incidence of acute rejection. The incidence in the recipients with PRA level of more than 40% was also higher than those with lower PRA level (<20%, 53.3% vs 22.7%, P<0.05), and the amino acid residual mismatch with 3-4 MM was responsible for a higher incidence in comparison with a mismatch with 0-1 MM (75.0% vs 24.1%, P<0.01). Postoperative elevation of PRA level also increased the risk of acute rejection (45.4% vs 22.4%, P<0.01). Conclusion TNF-α, IL-10 gene polymorphism, PRA, amino acid residual mismatch, and increased postoperative PRA level may significantly influence acute rejection in sensitized kidney transplantation recipient, and preoperative evaluation of these factors may benefit the designing of immunosuppressive protocols for these patients.