肾移植受者群体反应性抗体监测的临床意义

The detection of panel reactive antibody in kidney transplantation

目的分析群体反应性抗体(PRA)监测对预测肾移植受者排斥反应发生的意义及探讨对高水平PRA受者的临床处理。方法应用酶联免疫吸附分析法(ELISA法)动态监测肾移植受者的PRA水平,以PRA≥10%为阳性,10%≤PRA<50%为低致敏、PRA≥50%为高致敏,并对37例术前高致敏患者行血浆置换。结果1527例肾移植受者中,PRA阳性350例(22.9%),其中高致敏94例(26.8%);PRA阳性组排斥反应发生率(21.1%)高于PRA阴性组(3.8%,P<0.01),术后PRA转为阳性组排斥反应发生率高于PRA无变化组(P<0.01),行血浆置换受者与未行血浆置换受者排斥反应发生率无差异(P>0.05),接受过移植、多次妊娠、多次输血受者易致敏,HLA-A、B、DR配型错配抗原>3个受者急性排斥的发生率(16.9%)明显高于错配抗原≤3个受者(1.7%,P<0.01)。结论动态监测PRA水平有助于预测排斥反应的发生。

Objective The topic of human leukocyte antigen （HLA）-specific antibodies in transplantation has experienced a renaissance in the last decade with a renewed appreciation of their clinical relevance and an increased interest in their detection, identification, and treatment. This study was to investigate the role of panel reactive antibody （PRA） in kidney transplantation and clinical measures for recipients with high level PRA. Methods Serum PRA in 1527 cases of renal transplant recipients was determined by enzyme-linked immunosorbent assay （ELISA） with Lambda antigen tray （LAT）. According to the PRA level, the recipients were divided into negative group（ PRA 〈 10%）, positive group（ PRA≥10%）, and 2 subgroups with 10% ≤PRA 〈50% （lowly sensitized） and PRAy〉 50% （highly sensitized）. Plasma exchange therapy was used in 37 highly sensitized patients before transplantation. Results A total of 350 cases were detected positive PRA with a positive rate of 22.9%. Among them, 94 （26.8%） were highly sensitized. The rejection rate in the recipients with pretransplant positive PRA was 21.1% and only 3.8% in the negative PRA recipients （P 〈0.01 ）. The incidence of rejection of recipients with positive PRA after transplantation was higher than those with negative PRA （P 〈 0.01 ）. No difference in the incidence of rejection was found between the recipients with plasma exchange or not. Patients who had history of transplantation, pregnancies, or transfusion were more susceptible. The rejection rate of patients with 〉 3 HLA-A, B, or DR antigen mismatched was markedly higher than those with ~〈3 mismatched （ 16.9% vs 1.7%, P 〈 0.01 ）. Conclusion The detection of PRA before and after renal transplantation plays a very important role in predicting the occurrence of rejection.