肾移植受者术前致敏状态对肾移植效果的影响——附1209例分析

The effect of sensitized condition of recipients before renal transplantation on kidney transplantation

目的:探讨肾移植受者的术前致敏状态对肾移植效果的影响。方法:总结分析1209例肾移植受者术前的致敏状况[包括群体反应性抗体(panel reactive antibody,PRA)水平及白细胞抗原(human leucocyte antigen,HLA)类型]与肾移植效果[包括急性排斥反应、肾移植功能延迟恢复的发生率及移植肾存活率]之间的关系。结果:1209例中97例PRA阳性,其中轻度致敏62例(5.1%),中度致敏20例(1.7%),高度致敏15例(1.2%)。97例致敏受者共检出HLAⅠ类抗体阳性54例,HLAⅡ类抗体阳性32例,HLAⅠ和HLAⅡ类抗体均阳性11例。PRA阳性各组术后排斥反应发生率和肾功能延迟恢复率明显高于阴性组(均为P<0.01)。HLAⅠ类和HLAⅡ类抗体均阳性组的肾功能延迟恢复率(45%)明显高于Ⅰ类或Ⅱ类抗体阳性组(分别15%和19%)。致敏受者的移植肾存活率也低于非致敏受者(P<0.01)。结论:肾移植受者术前致敏状态对肾移植效果有明显影响。术前检测致敏状态相关指标,可以及时准确了解受者对供体的致敏状态,预测移植的效果,指导配型与治疗。

Objective： To investigate the effects of sensitized condition of recipients before renal transplantation on kidney transplantation. Methods： 1 209 recipients were reviewed for sensitized condition including panel reactive antibody （PRA）, the type of human leucocyte antigen （HLA Ⅰ , Ⅱ ） and their impacts on kidney transplantation including acute rejection, delay graft function rates and graft survival. Results： 97 PRA-positive specimens were identified from 1 209 patients. There were 62 （5.1% ） mild-sensitized patients, 20 （ 1.7% ） modest-sensitized patients and 15 （ 1.2% ） highly-sensitized patients. Among these sensitized patients, 54 had anti-HLA Ⅰ antibodies, 32 had anti-HLA Ⅱ antibodies and 11 had both antibodies. The rejection and delay graft function rate in PRA-positive group were significantly higher than those of PRA-negative group （P 〈0. 01 ） . The delay graft function rates were significantly higher in the group of both anti-HLA Ⅰ and Ⅱ antibody positive than those in the group with either anti-HLA I or Ⅱ antibody positive alone, respectively. Graft survival in PRA-positive group was significantly lower than that of the PRA-negative group. Conclusion ： Detection of PRA predicts sensitized status of the recipients and the presence of HLA antibodies has significant impacts on graft survival and rejections. Pre-operative determination of sensitized condition helps to assess recipients sensitized statu, predict outcome of transplantation and guide HLA type matching and treatment.