肾移植受者血清中抗供者特异性抗体检测及预测排斥反应的意义

Detection of donor-specific anti-HLA antibodies in recipients of renal transplant and its clinical significance to predict rejections

目的研究肾移植受者体内的HLA致敏状态以及抗供者特异性抗体在预测排斥反应中的作用。方法提取供者的HLA特异抗原,用ELISA法检测受者血清中抗供者特异性抗体(DSA),结合群体反应性抗体(PRA)检测结果及临床急性排斥反应的发生进行统计分析。结果肾移植前血清DSA阳性的受者,急性排斥反应发生率(63.2%)远高于DSA阴性的受者(14.7%)(P<0.01);术后DSA阳性的受者排斥反应的发生率也升高;DSA随着PRA水平的升高阳性率也增加(P<0.01)。结论抗供者特异性抗体对临床筛选供体、预测术后排斥反应及提高移植物的存活率有重要意义。

Objective To investigate the HLA sensitized status of the receptors,and to evaluate the contribution of monitoring donor-specific anti-HLA antibodies （DSA） to predict rejections. Methods The HLA glycoprotein from lymphocytes of the donors was extracted and to detect the donor-specific anti-HLA antibodies in serum of the receptors were detected by enzyme linked immunosorbent assay （ELISA）, and its clinical significance was analyzed combined with panel reaction antibody （PRA） and occurrence of acute rejections. Results The incidence of allograft rejections in the receptors who were DSA positive before transplantations was higher （63.2%） than the that in the receptors with negative DSA （ 14.7% ,P 〈 0.01 ）. The incidence of rejections in the DSA positive receptors rose after transplantation and the positive rate of DSA associated with PRA level （ P 〈 0.01 ）. Conclusions The donor-specific anti-HLA antibody is a very effective parameter to display the sensitization Situations in vivo of patients,and it may play significant role for the selection of appropriate donors, the prediction of the rejections and the increased survival rate of graft.