供体脾灌注对高度致敏患者移植肾的免疫保护作用

Immune Protective Effect of Donor Spleen Perfusion for the Renal Allografts of Highly Sensitized Candidates

目的探讨供体脾灌注对高度致敏患者移植肾的保护作用及机理。方法对16例高度致敏患者进行配对分组,实验组肾移植术中先予供体脾灌注。前瞻性观察脾灌注对受者群体反应性抗体(penel reactive antibody,PRA)、补体依赖细胞毒性(complement dependent cytotoxicity,CDC)试验、血清补体溶血活性(CH50)、可溶性人类白细胞抗原Ⅰ(soluble human leucocyte antigen-Ⅰ,sHLA-Ⅰ)以及术后早期移植肾排斥反应和移植肾功能的影响。结果供体脾灌注40min后,患者的PRA、CDC和CH50较灌注前显著降低,血清sHLA-Ⅰ浓度显著增加。对照组肾移植术后发生超急性排斥1例,加速性排斥反应3例,急性排斥反应3例。对照组排斥反应严重程度明显较灌注组高(u=2.54,P<0.05);对照组排斥反应发生时间为(3.3±2.6)d(中位数3.0d),脾灌注组为(10.5±6.2)d(中位数8.5d),组间比较差异具有统计学意义(t=10.46,P<0.01);术后近期血肌酐(serumc reatinine,Scr)值显著高于脾灌注组。结论供体脾灌注可以延缓高度致敏患者术后近期移植肾排斥反应的发生,减轻排斥反应强度,改善移植肾功能;其机制可能与供体脾脏特异性吸附受者毒性抗体,消耗血清补体和分泌s HLA-Ⅰ类抗原有关。

Objective To assess the immune protective effect and mechanism of donor spleen perfusion for the renal allografts of highly sensitized candidates.Methods Sixteen highly sensitized patients were paired and averagely grouped into experimental and control groups. Affect of donor spleen perfusion on panel reactive antibody （PRA）,complement dependent cytotoxicity （CDC）,total hemolytic complement levels （CH50）,soluble human leukocyte antigen-Ⅰ （sHLA-Ⅰ）,rejection episodes and renal allograft function were prospectively observed.Results Forty minutes after spleen perfusion,serum level of PRA,CDC and CH50 declined significantly;sHLA-Ⅰlevel,in contrast,increased significantly.There were 1 case of hyperacute rejection,3 cases of accelerated rejection and 3 cases of acute rejection in control group.In spleen perfusion group there were mainly acute rejection.The severity of rejection in spleen perfusion group was milder than in control （u=2.54,P0.05）.Rejection occurrence time was 3.3±2.6 days （with median 3.0 days） in control,which was significantly earlier than in spleen perfusion group （10.5±6.2 days,with median 8.5 days,t=10.46,P0.01）.The serum creatinine level was significantly higher in control group.Conclusion Donor spleen perfusion may delay the occurrence time of rejection in early phase after operation in highly sensitized candidates and ameliorate the severity of rejection so as to improve the renal allograft function.The mechanism may owe to specific absorption of cytotoxicity antibody and complement or excretion of sHLA-Ⅰ by the donor spleen.