移植肾切除对特异性抗HLA抗体水平的影响

The impact of allograft nephrectomy on the level of anti-HLA antibody

目的探讨移植肾切除对患者血中抗HLA抗体的影响。方法采用LAT抗原板、微量酶联免疫吸附法测定血中特异性抗HLA-Ⅰ类、Ⅱ类IgG抗体水平,比较分析37例致敏患者移植肾切除前后抗HLA抗体水平。结果37例患者中,术前抗HLA-Ⅰ类抗体升高9例(24.3%),Ⅱ类抗体升高12例(32.4%),两类抗体均升高者16例(43.2%)。移植肾切除后3、6、12个月时的抗体总水平与术前相比差异无统计学意义。25例术前Ⅰ类抗体升高的患者,术后6个月内抗体降至正常或下降>30%者9例(36.0%),术后12个月时降至正常或下降>30%者8例(32.0%)。术后Ⅰ类抗体下降至正常或<20%者,术前均<30%。28例术前Ⅱ类抗体升高患者中,术后6个月内降至正常或下降>30%者7例(25.0%),术后6个月内抗体水平未下降者,此后下降的可能性更小。结论对等待再次移植的PRA升高患者不应一律行移植肾切除,轻度致敏(PRA<30%)患者宜尽早切除移植肾。

Objective To explore the impact of allograft nephrectomy on the level of anti-HLA antibody. Methods This study included 37 patients who had been sensitized to the allografts and then undergone allograft nephrectomy. In them the Lambda LAT antigen plate was adopted to estimate the levels of anti-HLA Ⅰ and Ⅱ antibodies by enzyme-linked immuno-sorbent assay. The results of anti-HLA antibody of preand post-operation in the 37 patients were analyzed retrospectively. Results Among the 37 patients, the level of anti-HLA Ⅰ antibody alone was elevated in 9 （24.3%） before nephrectomy; the level of anti-HLA Ⅱ antibody alone was elevated in 12 （32.4%） ;and the levels of both anti-HLA Ⅰ and Ⅱ antibodies were elevated in 16 （43.3%）. There were no significant differences in the total levels of anti-HLA Ⅰ and Ⅱ anti-bodies at 3,6,12 months after graft nephrectomy compared with those before operation. However,in 25 patients with elevated level of anti-HLA Ⅰ antibody before operation, the level of anti-HLA Ⅰ antibody decreased gradually to normal level or by 〉 30% in 9 （36. 0% ） within 6 months postoperatively, in 8 （32.0%） within 12 months. In patients whose anti-HLA Ⅰ antibody level decreased to normal or less than 20% postoperatively,all of them had had levels less than 30% preoperatively. In 28 patients with the elevated level of anti-HLA Ⅱ antibody before operation, the level of anti-HLA Ⅱ antibody decreased gradually to normal level or by 〉 30% in only 7 （25%） within 6 months postoperatively. If the level of anti-HLA Ⅱ antibody did not fall within 6 months after graft nephrectomy, there was little possibility for the level to decrease. Conclusions Graft nephrectomy may be a choice for the retransplant-awaiting recipients with the level of anti-HLA Ⅰ antibody less than 30% , but this operation should be performed cautiously for other patients.