肾移植后急性排斥反应发生相关术前因素分析

Pre-transplant impact factors of acute rejection after kidney transplantation

目的探讨影响肾移植术后发生急性排斥反应的相关术前因素,为预防移植肾急性排斥反应的发生提供临床依据。方法回顾性分析2002年1月～2008年12月在浙江大学医学院附属第一医院肾脏病中心首次接受同种异体尸体肾移植受者1316例资料,记录基线资料及术后急性排斥反应发生情况;按群体反应性抗体(PRA)水平<10%和≥10%将受者分为PRA阴性组和致敏组;以2005年10月1日为界分为回顾性HLA配型组和前瞻性HLA配型组。统计分析各基线资料对术后急性排斥反应发生的影响以及不同组间急性排斥反应发生率的差异。结果手术时受者年龄、术前PRA水平、热缺血时间、HLA错配数对术后急性排斥反应的发生有显著影响。致敏组术后6个月内急性排斥反应发生率(58.8%比17.9%,P<0.001)以及6个月内组织病理学检查证实急性排斥反应发生率(29.4%比11.9%,P=0.028)均显著高于PRA阴性组。采用前瞻性HLA配型后受者HLA错配数减少,且术后6个月内急性排斥反应发生率也降低(20.9%比15.5%,P=0.012)。结论术前检测受者的PRA水平从而准确评估其致敏状态,尽可能选择良好的HLA配型谱可减少移植肾术后急性排斥反应的发生。

Objective To explore the pre-transplant impact factors of acute rejection after kidney transplantation in order to provide clinical basis for the prevention of acute renal rejection. Methods Baseline data and occurrence of acute rejection in 1316 recipients who received cadaveric renal allograft transplant during January 2002 to December 2008 were retrospectively analyzed. Recipients were divided into panel reactive antibody （ PRA）-negative group （ PRA〈 10% ） and the sensitized group （ PRA≥10%） . HLA typing method was retrospective before October 1,2005 and prospective after that day. The impact of baseline data on acute rejection,as well as the differences in the incidence of acute rejection between different groups were statistically analyzed. Results Age,pre-transplant PRA level, warm ischemia time,and HLA mismatch number had a significant effect on the incidence of acute rejection. The incidence of general acute rejection （ 58. 8% vs 17. 9% ,P〈0. 001） and biopsy-proved acute rejection （ 29. 4% vs 11. 9% ,P = 0. 028） within 6 months posttransplant were higher in the sensitized group than those in the PRA negative group. After the adoption of prospective HLA typing, HLA mismatches were reduced,and the incidence of general acute rejection within 6 months post-transplant significantly decreased （ 20. 9% vs 15. 5% ,P = 0. 012） . Conclusion To detect the recipients＇ PRA level and to apply HLA typing method before transplant may reduce the incidence of acute rejection after renal transplantation.