6025例肾移植供受者人类白细胞抗原错配率的分析

Analysis of HLA mismatch rate between the recipients and the donors in 36 kidney transplantation centers

目的:分析肾移植供受者间人类白细胞抗原(human leucocyte antigen,HLA)错配率。方法:来自36家移植中心的6 025例肾移植供、受者分为两组:3 916例等候肾移植受者和1 914例尸体供者为未知组;已接受肾移植术的127例受者和68例尸体供者为已知组。未知组为肾移植最大可能的供受者对,而已知组为实际的肾移植供受者对。统计并比较两组供受者间HLA-A、B、DR各位点0～2个错配(mismatch,MM)概率。结果:未知组供受者间HLA-A位点0～2 MM的概率分别为10.24%、51.79%和39.33%;B位点0～2个MM的概率分别为2.19%、33.68%和64.13%;DR位点0～2 MM的概率分别为3.69%、40.97%和55.34%。已知组供受者间HLA-A位点0～2 MM的概率分别为9.45%、58.27%和32.28%;B位点0～2 MM的概率分别为6.30%、30.71%和62.99%;DR位点0～2 MM的概率分别为7.87%、45.67%和46.46%。两组间比较仅B和DR位点0个MM差异有显著统计学意义,各位点1和2个MM的概率比较无显著差异。未知组和已知组供受者A、B、DR位点,2个MM的概率与0 MM的概率相比差异具有显著性。结论:肾移植供受者间HLA错配概率高,为降低HLA错配率,有必要建立国家级或地区性器官共享和分配中心。

Objective ： To analyse the HLA mismatch rate between donor and recipient of renal transplantation. Methodology：6 025 cases of donors and recipients from 36 organ transplantation centers were enrolled in this study. They were divided into two groups. 3 916 cases of recipients who were waiting for renal transplantation and 1 914 eases of cadaver donors for the first group, as the unknown group; 12＂7 cases of recipients who had received renal transplantation and 68 cases of cadaver donors for the second group, as the known group. The maximum possible transplanted pairs of recipient-donor were considered in the unknown group, and the actual transplanted pairs of recipient-donor in the known group. 0 - 2 MM rates at HLA-A, B, and DR locus were statistical analysed in the unknown group, 0 -2 MM rates at HLA-A,B, and DR locus and 0 -6 MM rates with 6 antigens were in the known group. 0 -2 mismatch rate at single locus of HLA-A, B and DR between two groups were compared. Results：In the unknown group, the rate of 0 -2 MM were 3.69% , 40. 97% and 55.34% at HLA-A locus; 2. 19% ,33.68% and 64. 13% at B locus; and 3.69% ,40.97% and 55.34% at DR locus. In the known group, the rate of 0 -2 MM were 9. 45%, 58. 27% and 32. 28% at A locus; 6. 30%, 30. 71% and 62. 99% at B locus ; and 7.87%, 45.67% and 46. 46% at DR locus. The proportion of 0, 1, 2, 3,4, 5, and 6 MM was 0, 0. 79% , 5.51% , 23.6% , 27.6% , 29. 9% and 12. 60% respectively. However,there were significantly different on the 0 MM rate at B and DR locus between the two groups, and at each locus in each group. The proportion of 2 MM was significantly higher than that of 0 MM, but the rate of 1 and 2 MM at each locus of the known group was not significant compared with that of the unknown groups. Conclusion：The rate of HLA mismatch between donor and recipient in renal transplantation is high. It is necessary to establish a national or regional organ sharing and distribution center in order to reduce the rate of HLA mismatch.