灵长类动物预致敏后肾移植加速排斥反应模型的建立

Accelerated rejection model of renal allotransplantation in presensitized non-human primates

目的建立灵长类动物预致敏后肾移植加速排斥反应模型。方法取血型相容的正常猕猴配对，预先将供者腹部全层皮肤移植到受者背部，使受者预致敏。2周后再将同一供者的左侧肾脏移植到受者腹腔内，同时切除受者自体双。肾，术后予以环孢素A、霉酚酸酯和泼尼松治疗（致敏用药组），不用免疫抑制剂者为对照（致敏对照组），以未致敏的肾移植作为对照组。术后观察受者血肌酐变化、移植物存活时间及病理特点。结果对照组的4只移植肾存活时间分别为9、18、8、7d；致敏对照组的3只移植肾存活时间分别为3、3、4d；致敏用药组的3只移植肾存活时间分别为2、3、4d。移植皮肤于术后10d出现排斥反应，至术后14d被完全排斥。对照组于肾移植1周以后才发生排斥反应，而致敏者均在肾移植后3d左右发生较严重的排斥反应。结论受者被供者皮肤预致敏后再行肾移植，可以加速移植物的排斥，且不能被环孢素A、霉酚酸酯及泼尼松所组成的三联免疫抑制方案逆转。

Objective To establish an accelerated rejection model of renal allotransplantation in presensitized monkeys. Methods Recipient rhesus monkeys were presensitized by grafting of skin grafts from ABO-eompatible donor monkeys and subsequently received a kidney from the same donor two weeks later. These presensitized recipients were treated with CsA ＋ MMF ＋ prednisone （presensitized treated group）, and without as a control （presentized control group）. In comparison with non-presensitised control group, the changes of serum creatinine levels, survival time and the pathology of grafts were observed and studied. Results Four renal grafts in non-presensitized control group survived for 7, 8, 9 and 18 days respectively. In contrast, 3 presensitized recipients without treatment rejected allografts at 3rd, 3rd, 4th day respectively. Three presensitized recipients with triple therapy rejected allografts at 2nd, 3rd, 4th day respectively. The rejection of the skin grafts was first observed at 10th day after skin transplantation, and completed on 14th day. Non-presensitized recipients rejected kidney allografs regularly happening after a week, by comparison, allografts were rapidly rejected on 3rd day in presensitized recipients. Conclusion Presensitization by donor skin can accelerate allograft rejection, which can not be reversed by the administration of CsA in combination with MMF and prednisone.