肾移植受者抗HLA抗体监测的临床意义

Clinical significance of monitoring anti-HLA antibody in recipients undergoing renal transplantation

目的探讨动态监测肾移植受者抗HLA抗体的临床意义。方法采用酶联免疫吸附试验(ELISA)对1517例肾移植受者进行手术前、后血清群体反应性抗体(panel reactive antibody,PRA)强度动态监测,对PRA阳性受体进一步行抗HLA抗体分型并进行随访,观察PRA水平对移植物长期存活和移植肾功能的影响。结果1517例中,术前PRA阴性者1336例,阳性者181例。术前PRA阳性受者和阴性受者的移植物功能延迟恢复(DGF)发生率分别为34.8%、11.9%,两组比较差异有统计学意义(P<0.01)。术前PRA阳性受者的移植肾1、3、5、8年存活率分别为94%、85%、73%和63%,术前PRA阴性受者相应为96%、87%、72%和65%,两组比较差异均无统计学意义(P>0.05)。移植前及移植6个月后PRA均为阴性的265例受者中,血清肌酐水平异常者仅占19.6%,而术后PRA转为阳性的57例受者中,血清肌酐异常者高达61%,两者比较差异有统计学意义(P<0.01);移植前PRA阳性的53例受者中,有24例移植后PRA转为阴性,术后血清肌酐全部正常。结论术前筛查PRA可科学评估肾移植患者的体液致敏状态,为致敏患者选配合适供者;术后监测PRA可及时了解移植肾的免疫状态,有利于防治排斥反应。

Objective To explore the significance of monitoring of anti-HLA antibodies in kidney recipients.Methods The sera of 1 517 recipients were screened for PRA by ELISA with Lambda mixed antigen tray （LATM）,and the positive sera were further assayed with Lambda antigen trays （LAT1240 and LAT1HDS） to determine the specificity of antibodies to HLA antigens.The recipients with positive sera were followed up and the effects of PRA on long-term survival of allografts were recorded.Results Among 1 517 recipients,1 336 of them were found to be PRA negative and 181 to be positive pre-transplantation.The incidence of developing delayed graft function （DGF） in positive recipients was significantly higher than that in negative ones （34.8 % vs 11.9 %,P 0.01）.The graft survival rates at 1,3,5 and 8 years after kidney transplantation in positive and negative recipients were 94 % vs 96 %,85 % vs 87 %,73 % vs 72 % and 63 % vs 65 % respectively,showing no statistical difference between these two groups of recipients at all these 4 time points （P 0.05）.19.6% of 265 patients （n =52） who had negative PRA pre-transplantation and 6 months post-transplantation showed increased creatinine,while 61% in 57 recipients （n =35） with PRA positive post-transplantation had increased creatinine.There was significant difference between the two groups （P 0.01）.Among 53 PRA positive recipients pre-transplantation,24 cases were found to become PRA negative and had normal creatinine level post-transplantation.Conclusion The screening of PRA pre-transplantation is essential for the evaluation of humoral sensitization and the selection of suitable donor.In addition,the detection of PRA post-transplantation is useful to evaluate immune status of recipients and to reduce the incidence of rejection.