人类白细胞抗原-氨基酸残基配型标准在肾移植中的临床应用

The application of HLA-amino acid residue matching in kidney transpla ntation

目的评价人类白细胞抗原氨基酸残基配型ResM标准在肾移植中的临床应用价值。方法回顾性分析112例首次尸肾移植氨基酸残基相配对急性排斥反应及1～5年存活率的影响,通过混合淋巴细胞培养和外周血免疫活性细胞检测,研究移植受者的免疫反应性。结果采用ResM标准可大幅度提高相配概率;移植肾早期急性排斥反应发生率与1～5年长期存活率接近抗原相配水平。残基相配组1～5年人存活率提高11.0%～22.1%P<0.05、肾存活率提高18.1%～35.0%P<0.01;残基相配的受者,术后MLC刺激指数和外周血CD8、CD28、CD4CD8比值与抗原相配者接近,优于残基或抗原错配组。结论ResM标准具有实用性与可行性,可以降低术后患者的致敏性和免疫反应性,适合肾移植临床应用。

Objective To evaluate the clinical application of HLA-amino ac id residue matching (Res M) in kidney transplantation. Methods The effects of R es M on acute rejection and 1～5 years graft survival were retrospectively analy zed in 112 recipients of primary transplantation with cadaver kidney. The immuno genic response to allograft was assayed by using the mixed lymphocyte culture an d immune competent cells in the peripheral blood. Results The matching rate wit h Res M increased greatly. The rate of early acute rejection and 1～5 years gra ft survival in Res M matched grafts were similar to those using antigen matching (Ag M). 1～5 years recipient survival was increased by 11.0%～22.1%(P<0.05) and graft survival was increased by 18.1%～35.0% (P<0.01) in Res M matched recipien ts. The immune response indices including SI of MLC, CD8, CD28 T cells and the r atio of CD4CD8 in Res M matched recipients were similar to those of Ag M match ed transplants and better than in Res or Ag mismatched recipients. Conclusion R es M is of practicability and feasibility, and can be used in to clinical kidney transplantation.