供、受者间HLA等位基因错配对肾移植后亚临床急性排斥反应的影响

Impact of HLA allele mismatching between recipients and donors on subclinical acute rejection after renal transplantation

目的探讨供、受者间HLA等位基因错配对肾移植后亚临床急性排斥反应（SAR）的影响。方法以行首次同种异体。肾移植的56例患者为对象，移植术前患者的群体反应性抗体均为阴性。采用序列特异性引物聚合酶链反应技术进行供、受者HLA亚型的鉴定。移植后使用环孢素A（或他克莫司）、霉酚酸酯以及泼尼松预防排斥反应，术后3个月内临床上无急性排斥反应征象。术后第90天时，行移植肾穿刺，采用Banff97标准诊断SAR。结果56例中，共有12例发生SAR。HLA-A位点1个抗原错配者中，6例（18．8％，6／32）发生SAR．2个抗原错配者中，3例（23．1％，3／13）发生SAP，无抗原错配者中，3例（27．3％，3／11）发生SAR．三者间的发生率相比较，差异无统计学意义（P〉0．05）。HLA-B位点1个抗原错配者中，3例（8．8％，3／34）发生SAR，2个抗原错配者中．8例（72．7％。8／11）发生SAR，无抗原错配者中，1例（9．1％，1／11）发生SAP，2个抗原错配者的SAR发生率明显高于1个抗原错配者和无抗原错配者（P〈0．01）。HLA-DR位点1个抗原错配者中，6例（14．6％，6／41）发生SAR．2个抗原错配者中，6例（100％，6／6）发生SAP，无抗原错配者均未发生SAR．三者间的发生率相比较，差异有统计学意义（P〈0．01）。HLA-DR位点2个抗原错配者和HLA-B位点2个抗原错配者的SAR发生率均明显高于HLAA位点2个抗原错配者（P〈0．01）；HLA-DR位点无抗原错配者与HLA-A位点无抗原错配者的SAP,发生率相比较，差异有统计学意义（P〈0．05）。结论供、受者间HLA-DR及HLA-B的错配与SAR的发生明显相关．HLA-A抗原的配型满意度对术后SAR的影响不明显。

Objective To evaluate the impact of HLA allele mismatching between recipients and donors on subclinical acute rejection （SAR）. Methods A total of 56 kidney allograft recipients negative for PRA before transplantation were treated with a combination of CSA, MMF and prednisone and underwent an allograft biopsy at 3rd month after transplantation. The biopsies were scored by a blinded pathologist according to the Banff criteria （Canada, 1997）. Results SAR was seen in 12 patients （21.5%）. These 6 patients with 2 HLA-DR mismatching had all met the criteria of SAR, whereas SAR was present in only 0 （0/9） and 14. 6% （6/41） of patients with respectively 0 and 1 HLA-DR mismatching （P〈0. 01）. 9. 1 %（ 1/11 ）, 8. 8% （3/34） and 72. 7% （8/11） of patients with 0, 1and 2 HLA-B mismatches had met SAR, with the difference being repectively between 0,2 HLA-B mismatches and 1,2 HLA B mismatches （P〈0.01 ）. Also respectively 27. 3% （3/11 ）, 18. 8% （6/23） and 23. 1% （3/13） of patients with 0, 1 and 2 HLA A mismatches had SAR （P〉0. 05）, with the difference being not significam among them. Conclusion This retrospective study suggest that HLA-DR and HLA-B mismatching plays an important role in the occurrence of SAR, the extent of impact is ohserved as HLA-DR〉 HLA-B. On the other hand, HLA-A has no significant impact on the occurrence of SAR.