微嵌合体在母亲子女之间活体肾移植中的作用

Analysis of microchimerism in living renal transplantation between mothers and children relationship

目的观察不同供受体关系亲属活体肾移植的临床疗效及其与微嵌合体之间的关系。方法回顾性分析复旦大学附属中山医院2004-2008年130例亲属肾移植临床资料。受者随访1—5年，利用微卫星及性染色体决定基因聚合酶链反应（PCR）技术检测外周血DNA微嵌合体，并根据随访结果，分析微嵌合体的作用。结果受者1-年人／肾存活率分别为93．8％和92．3％，各供受者组关系比较发现1－年人／肾存活率差异均无统计学意义（均P〉0．05）。130例受者中46例（35．4％）行移植肾穿刺活检，病理结果证实发生急性排斥反应26例，急性排斥反应发生率为20．0％（26／130）。26例中14例（53．8％）为母亲子女之间。肾移植，12例（46．2％）为其他供受者关系肾移植。母亲子女肾移植中急排斥反应发生率为30．4％（14／46），高于其他供受者关系肾移植急性排斥反应发生率（14．3％，12／84，P=0．028）。130例受者中43例术后不同时间进行了外周血微嵌合体检测，在其中16例母亲供肾的受者中，4例检测到微嵌合体，阳性率25．0％；27例其他供者的受者中，4例检测到微嵌合体，阳性率为（4．8％；母亲供肾微嵌合体阳性率比其他关系高约1倍。微嵌合体阳性组急性排斥反应发生率较微嵌合体阴性组高约1倍。结论母亲子女之间肾移植急性排斥发生率较高；母亲供肾的微嵌合率较高；微嵌合率高的组别急性排斥反应较高；母亲子女之间特殊的免疫学关系可能影响肾移植效果。

Objective To compare the microchimeric and rejection rates in living donor kidney transplant recipients in mother and child relations arid other relations, Methods This retrospective single- center study enrolled 130 recipients to receive allografts from living related donors from 2004 to 2008 at our hospital. They were followed up for 1 - 5 years. The demographic data of the study population were analyzed by basic statistical methods. A total of 43 recipient blood samples were collected for the detection of microchimerism by the assays of short tandem repeat （STR） and sex-determining region-y gene （SRY） polymerase chain reaction （PCR）. Results The 1-year patient/graft survival rates were 93.8% and 92. 3% respectively. And there was no significant differences between mother and child group and other relative group. Forty-six biopsy samples were collected from 46 recipients. Twenty-six （20. 0% ） cases had the occurrences of acute rejection episodes in different Banff degrees as proven by biopsy. 53.8% （14/26）cases were mother and child renal transplantation, higher than other relative （46. 2%, 12/26 ） . The mother donor kidney transplant recipients had about a twice higher rejection rate （30. 4% vs 14. 3%, P = 0. 028 ） and a twice higher microchimeric rate（25.0% vs 14. 8% ） than other relative. Conclusion Compared with other relations, the mother donor kidney recipients tend to have higher rates of microchimerism and acute rejection. And the special immune effect in mothers and children renal transplantation may influence its outcomes.