动态监测供者特异性抗体与非供者特异性抗体判断移植肾预后的临床意义

The clinical significance of dynamic monitoring DSA and NDSA on renal allograft prognosis

目的动态监测肾移植前后供者HIJA特异性抗体（DSA）及非供者HLA特异性抗体（NDSA）的变化，观察其对移植肾预后的影响。方法采用免疫荧光液相芯片（Luminex）技术检测8例肾移植患者术前HIA基因分型、术前和术后的特异性HLA抗体改变。结果术前HLA抗体阴性者4例，术后1例并发肺部感染死亡，另3例半年内HLA抗体阴性，肾功能良好。2例移植前后检测HLA抗体阳性，术后半年抗体滴度明显逐渐增高，分离出DR11（DSA）；DR12、DQ7、DQ8（NDSA）。1例术前存在A11（DSA），A34（NDSA）抗体，术后1个月始NDSA增多，且其分值呈上升趋势。1例术前存在DR15（DSA）抗体，术后1周发生急性排斥反应行移植肾切除。结论肾移植前受者存在DSA会导致移植肾急性排斥，特别是存在HLA-Ⅱ类抗体。在随访期间HLA抗体滴度和类型持续升高者，应鉴定其DSA与NDSA类型，尽早采用有效的治疗方法减少移植’肾功能减退及排斥反应的发生和发展。

Objective To study the influence of DSA and NDSA on renal allograft prognosis by dynamically monitoring their changes before and after Tenal transplantation. Methods In 8 cases of renal transplantation,the HLA genotyping and anti-HLA antibodies before transplantation as well as DSA and NDSA after transplantation were detected by flow PRATM beads. Results Four patients had no anti-HLA antibody before transplantation. Except one patient died of severe p,dmonary infection after transplantation and the remaining 3 patients with no anti-HLA antibodies within 6 months after transplantation had well functional renal allograft. Two patients were positive for anti-HLA antibodies preoperation, the specialties HLA antibody could been detected, DR11 was DSA ; DR12 and DR4 were NDSA,respectively. The one patient had antibodies of All and A34 before transplantation, positive rate had increased after six month transplantation. The other one patient was detected antibodies of DR15 before transplantation and developed acute rejection and rupture of renal allogTaft one week after transplantation, therefore the nephrectomy was performed. Conclusion The recipients with DSA preoperative,especially anti-HLA class II might induce acute rejection. DSA and NDSA should be detected if the antibody titer and typing keep on rising and effective therapy should be adopted early to decrease the occurrence and development of acute rejection and hypofunction on renal allograft.