亲属肾移植后群体反应性抗体的调查

Panel reactive antibody following living renal transplantation

背景:亲属肾移植后产生群体反应性抗体的频率如何,对术后移植肾功能和长期存活是否有影响,目前国内尚无相关报道。目的:调查亲属肾移植后群体反应性抗体产生的频率,为预测亲属肾移植长期存活提供参考资料。方法:纳入2005-03/2007-10收治的亲属肾移植患者54例,分别于移植后一两年内再次检测群体反应性抗体及血肌酐、尿素氮浓度。群体反应性抗体检测采用美国Onelanmbda公司提供的酶联免疫吸附法筛选HLA-Ⅰ类、Ⅱ类混合抗原板。血肌酐和尿素氮检测数据由检验科提供。结果及结论:54例亲属肾移植患者中有7例移植后产生了抗体,占12.96%。其中6例产生了抗HLA-Ⅱ类抗体,仅1例产生了抗HLA-Ⅰ,Ⅱ类抗体。在此7例患者中6例为初次肾移植,且肾移植前群体反应性抗体均阴性;1例为再次肾移植,移植前抗HLA-Ⅱ抗体阳性。1例具有抗HLA-Ⅰ+Ⅱ类抗体和2例高强度抗HLA-Ⅱ类抗体的患者血肌酐和尿素氮浓度均超过正常水平,而另外4例出现低水平抗HLA-Ⅱ类抗体的患者血肌酐和尿素氮浓度则在正常水平。结果提示,具有抗HLA-Ⅰ+Ⅱ类抗体和高效价抗HLA-Ⅱ类抗体影响亲属肾移植患者的肾功能,而低效价的抗HLA-Ⅱ类抗体并不影响亲属移植肾功能。

BACKGROUND：It remains poorly understood regarding the incidence of panel reactive antibody（PRA） production and its influence to renal function and long-term survival in China.OBJECTIVE：To investigate the incidence of PRA after living renal transplant,so as to provide reference for predicting long-term renal survival.METHODS：A total of 54 patients who received living renal transplantation in Beijing Friendship Hospital from March 2005 and October 2007,were selected.PRA,serum creatinine and urea nitrogen level were detected 1-2 years after transplantation.PRA assay was conducted using One Lambda ELISA HLA-Ⅰ＋Ⅱ antigen tray.Serum creatinine and urea nitrogen data were offered by clinical laboratory.RESULTS AND CONCLUSION：A total of 12.96%（7/54） patients showed PRA positive after transplantation,with HLA-Ⅱ antibody positive in 6 patients,and HLA-Ⅰ＋Ⅱ antibody positive in 1 patient.In these 7 patients,6 underwent primary transplantation,and PRA negative before transplantation;1 patient underwent transplantation for the second time,and HLA-Ⅱ antibody positive before transplantation.Creatine and urea nitrogen level were abnormal in 1 patient with HLA-Ⅰ＋Ⅱ antibody positive and 2 patients with HLA-Ⅱ antibody highly positive.Creatinine and urea nitrogen levels were normal in 4 patients with low level HLA-Ⅱ antibody.Results show that HLA-Ⅰ＋Ⅱ antibody positive and high level HLA-Ⅱ antibody affect renal function in living renal recipients,but low level HLA-Ⅱ antibody has no effect on renal function.