Res配型在致敏受者肾移植中的应用

Significance of HLA-amino acid residue matching in renal transplantation of sensitized recipients

目的:探讨致敏受者经HLA-氨基酸残基配型(Res配型)后行肾移植的效果。方法:对13例移植前群体反应性抗体水平较高的患者按照美国UCLA组织配型中心所确定的中国汉族人Res配型标准进行供、受者筛选,以常规方法进行肾移植,术前未行血浆置换。结果:13例患者,无一例发生超急排斥反应;9例术后5d内移植肾功能恢复正常;3例术后1个月内各出现1次移植肾急性排斥反应(发生率23%),1例经甲基强的松龙,2例经OKT3治疗后逆转;1例发生急性肾小管坏死,经血液透析过渡后,于术后3周肾功能逐渐正常。按Res配型原则,供、受者0、1、2和3个位点错配分别为1例(8%)、3例(23%)、7例(54%)和2例(15%),明显高于传统HLA六抗原配型结果。结论:Res配型可以显著提高供受者相配率,对缩短等肾时间,减少移植肾的排斥反应,提高移植肾的存活率具有重要意义。

Objective To investigate the role of HLA-amino acid residue matching in renal transplantation of sensitized recipients. Methods 13 patients with higher level of PRA were selected for donor-recipient HLA matching before renal transplantation according to the criteria for the Han population HLA-amino acid residue matching （Res M） established by American UCLA tissue matching center. The renal transplantation was performed by conventional methods without plasma exchange. Results Super acute rejection episodes occurred in none of 13 recipients. Kidney function recover was observed within 5 days in 9 cases of them. Acute rejection occurred in 3 cases of them （the incidence： 23.1%） within one month, and 1 case recovered after treatment with MP, and 2 cases with OKT3. 1 case was subjected to acute tubular necrosis and recovered normal renal function within 3 weeks. According to the Res matching, patients with 0, 1, 2 or 3 mismatching were 1 （8%）, 3 （23%）, 7 （54%） and 2 （15%） cases respectively. Obviously, Res matching was better than traditional HLA 6 antigen matching. Conclusions Application of Res M will significantly increase the chance and provide more time for waiting recipients. Suitable Res M can be beneficial to reducing the incidence of acute rejection and improving graft survival in sensitized renal recipients.