致敏肾移植受者主要组织相容性复合物I类链相关基因A抗体表达对预后的影响

Impact of MICA-Ab expression on the prognosis of sensitized renal transplantation recipients

目的探讨致敏肾移植受者（群体反应性抗体PRA〉20％）主要组织相容性复合物I类链相关基因A抗体（MICA．Ab）的表达对患者预后的影响。方法收集本院2007年8月至2010年4月行肾移植的致敏受者51例，其中29例接受蛋白A免疫吸附，并在吸附前后行MICA—Ab检查；另22例未接受免疫吸附，在入院时行MICA—Ab检查。回顾分析移植受者人类白细胞抗原（HLA）、急性排斥反应、术后1周和4周Scr水平与MICA—Ab的关系。结果51例受者中16例MICA—Ab表达阳性（31．4％），MICA—Ab表达阴性与阳性受者的急性排斥发生比例差异无统计学意义。PRA〉40％受者的MICA—Ab表达显著高于PRA≤40％受者（P〈0．05）。HLA错配对MICA—Ab表达无显著影响。在接受免疫吸附受者中，MICA—Ab阳性组和阴性组出院时Scr水平差异无统计学意义；未接受免疫吸附受者情况相似。MICA—Ab水平在蛋白A免疫吸附后显著下降。结论MICA—Ab在致敏受者中表达升高，然而对受者预后无显著影响。蛋白A免疫吸附可有效去除致敏受者体内MICA—Ab。

Objective To explore the effect of MICA-Ab expression on the prognosis of sensitized renal transplantation recipients. Methods A total of 51 sensitized recipients （PRA more than 20%） in our hospital from August 2007 to April 2010 were enrolled in the study. In these patients,29 cases received protein A immunoadsorption and detection of MICA-Ab was performed before and after protein A immunoadsorption. Other 22 patients received MICA-Ab detection when they were hospitalized. Associations of PRA, HLA-matches, acute rejection, and serum creatinine of postoperative week 1 and week 4 with MICA-Ab were analyzed retrospectively. Results Sixteen recipients （31.4%） had positive MICA-Ab expression but their acute rejection rate was not higher as compared to the patients with negative MICA-Ab expression. Recipients with PRA〉40% showed higher expression level of MICA-Ab than recipients with PRAy〈40% （P~〈0.05）. HLA-match did not show influence on MICA-Ab expression. MICA-Ab positive group had no higher serum creatinine level than negative group in postoperative week 4. MICA-Ab level decreased signifieantly after protein A immunoadsorption. Conclusions MICA-Ab expression increases in the sensitive recipients but does not influence the prognosis. Protein Aimmunoadsorption can eliminate MICA-Ab effectively in sensitized recipients.