氨基酸残基配型策略在高致敏尿毒症患者肾移植中的应用研究

APPLICATION OF HLA AMINO ACID RESIDUES MATCHING CRITERIA IN SENSITIZED URAEMIC RECIPIENTS

目的:探讨人类白细胞抗原(HLA)氨基酸残基配型(Res M)标准在高致敏尿毒症患者肾移植中的应用。方法:在动态监测群体反应性抗体(PRA)水平、特异性及淋巴毒交叉配合试验的基础上,采用ResM标准选取与供者最匹配的供体。结果:56例尿毒症患者术前PRA均大于20%,采用Terasaki提出的ResM标准,供受者0抗原错配(MM)为6例(10.7%),1MM为13例(23.2%),2MM为19例(33.9%),3MM为13例(23.2%),4MM为5例(9.1%),5MM和6MM为0例。术后56例受者均未发生超急性排斥反应,17例(30.4%)发生急性排斥,经甲基强的松龙冲击治疗后3例(5.4%)切除移植肾,另14例(25%)排斥反应逆转,肾功能恢复。5例(8.9%)发生移植物功能延迟恢复(Delay Graft Function,DGF),经血液透析过渡治疗后均在5周内恢复。结论:Res M标准可提高PRA阳性受者与供者之间HLA相配程度,缩短患者等肾时间,降低排斥反应的发生率,是一种有效的、具有临床实用价值的配型策略。

Objective： To study the HLA amino acid residues matching criteria in kidney transplantation. Methods：The dynamic panel reactive autibody （PRA） levels and the specificity were determined. Res M was used to select the most appropriate donor. Results： The preoperative PRA levels in 56 recipients were higher than 20%. According to the Res M of Terasaki, the 0 to 6 antigen mismatched detail is as follows： 6（10. 7%）, 13（23.2%）, 19（33.9%）, 13（23.2%）, 5（9. 1%）, 0 and 0. There was no hyper-aeute rejection detected among these 56 recipients. And 17 cases of acute rejection were detected. After concussion with radiosone, 5 transplanted kidneys were resected from 17 recipients. The others were reversed by the using of radiosone. Five recipients were got back by hemodialysis after the Delay Graft Function was detected, but they were both healed in 5 weeks. Conclusion： The HLA amino acid residues matching criteria is valuable and effectual in clinic by improving the matching rate, decreaseing time spending on waiting for donor and increasing using rate of organ.