肾移植术后新合成HLA抗体对移植肾功能的影响

Impact of de novo anti-HLA antibodies on renal allograft function

目的研究肾移植术后新合成人类白细胞抗原(HLA)抗体(denovo)对移植肾功能的影响。方法采用免疫荧光液相芯片技术检测54例肾移植术前HLA抗体阴性者术后新生的HLA抗体水平。抗体阳性者检测其特异性,并同时检测血清肌酐(SCr)水平,分析新合成HLA抗体对移植肾功能的影响。结果54例患者中,HLA抗体阳性13例(24.1%),其中Ⅰ类抗体阳性2例(3.7%),Ⅱ类抗体阳性9例(16.7%),Ⅰ类及Ⅱ类抗体均为阳性2例(3.7%)。HLA抗体阳性组血清SCr水平及SCr异常者的比例均高于阴性组(P<0.01)。HLA-Ⅱ类抗体水平升高者多伴有SCr水平升高。结论肾移植术后新合成HLA抗体会损害移植肾功能,以HLA-Ⅱ类抗体作用更明显;肾移植术后应监测HLA抗体的变化,对于抗体阳性者,应采取积极的治疗措施。

Objective To study the influence of de novo anti-HLA antibodies on renal allograft function. Mothods The levels and specialties of de novo anti-HLA antibodies of unsensitized before kidney transplantation were detected by Flow PRATM beads in 54 patients. In those with HLA antibody positive, their serum creatinine levels were tested simultaneously. The effect of de novo anti- HLA antibodies on renal allograft function was analyzed. Results HLA antibodies were found in 24. 1% （13/54） . Among them,2 cases （3.70/00） had anti-HLA class Ⅰ,9 cases （16.70/00） class Ⅱ and 2 cases（3.7%） had both anti-HLA class Ⅰ and class Ⅱ antibodies. The levels of serum creatinine and the percentage with abnormal serum creatinine in patients with anti-HLA antibodies were both higher than those without anti-HLA antibodies （P〈0. 01）. Most of the patients with anti-HLA class Ⅱ antibodies also had high levels of serum creatinine. Conclusion The renal allograft function could be impaired by de novo anti-HLA antibodies, especially by anti-HLA class Ⅱ. The anti-HLA antibodies should be monitored after renal transplantation and effective therapeutic measures must be taken to remove antibodies.