标准HLA配型与氨基酸残基配型在再次肾移植中的应用

HLA and HLA Amino Acid Residue Matching In Kidney Retransplantation

【目的】探讨人类白细胞抗原(HLA)配型(Ag M)和氨基酸残基配型(Res M)标准在再次肾移植受者中的应用。【方法】回顾性分析HLA配型、Res M及基因水平HLA-DR相容对78例再次肾移植患者早期肾功能、早期排斥反应及人/肾存活率的影响。【结果】应用Res M标准,0MM受者由AgM组2.6%提高到ResM组14.1%(P=0.0027),0～1MM组受者由Ag M组15.4%提高到ResM组52.6%(P<0.001);残基相配组与残基错配组相比,DR相配组与DR错配组相比:早期移植肾功能恢复快、早期排斥反应发生率显著减少,1、3年移植肾存活率明显提高(P<0.05)。【结论】HLA-Res M可大幅度增加供受者的相配概率,显著降低术后早期排斥反应发生率,适合在再次肾移植患者中应用。基因水平HLA-DR相容对再次肾移植术后早期排斥反应和存活率具有重要影响。

[Objective] To explore the applied value of HLA six-antigen match program （Ag M） and HLA amino acid residue matching （Res M） for recipients undergoing kidney retransplantation. [Methods] The influence of HLA matching, Res M, genomic HLA-DR compatibility on early renal function, early rejection episodes, and recipient/regraft survival rate were retrospectively analyzed in 78 cases of recipients undergoing kidney retransplantation. [Results] The rate of Res- matched transplants greatly increased. The rate of 0 mismatch （MM） recipients increased from 2.6% by Ag M to 14.1% by Res M, and that of 0-1 MM transplants from 15.4% to 52.6%. Early graft function, early rejection episodes and graft survival in well-matched recipients were better than those in poorly-matched patients. [Conclusions] The Res M can greatly increase the rate of Res-matched transplants, minimize the rate of early rejection episodes and be suitable to the clinical application for recipients undergoing kidney retransplantation. G enomic compatibility of HLA-DR has effect on early rejection episodes and regraft survival in kidney retransplantation.