HLA配型在致敏受者肾移植中的应用研究

A study of HLA matching in sensitized recipients of renal transplantation

目的 探讨人类白细胞抗原 (HLA)配型在致敏受者肾移植中的临床意义。方法 应用莱姆德细胞板通过补体依赖微量细胞毒性试验检测受者的群体反应性抗体 (PRA) ;应用单抗湿板进行供受者HLA Ⅰ类抗原分型 ;应用微量序列特异性引物 (Micro SSP)进行HLA Ⅱ类基因分型。结果 17例受者PRA阳性率为 5 .1%～ 80 % ,平均 37.9% ;按交叉反应组 (CREGs)配型原则 ,供受者HLACREGs 0 ,1和 2个错配 (MM)者分别为 5例 (2 9% )、8例 (4 7% )和 4例 (2 4% ) ,无 3～ 6个错配者 ;而按传统的HLA A ,B ,DR抗原配型原则 ,其 0 ,1和 2MM分别为 1例 (6 % ) ,1例 (6 % )和 8例 (4 7% ) ,3～ 4MM有 7例 (4 1% ) ;术后仅 3例发生急性排斥反应 ,经OKT3治疗后逆转 ,所有受者术后肾功能均恢复正常。结论 交叉反应组配型可显著提高供受者的HLA相配率 ;良好的HLA配型对减少致敏受者的肾移植排斥反应。

Objective To investigate the clinical implication of human leukocyte antigen (HLA) matching in sensitized recipients of renal transplantation. Methods Recipient's panel reactive antibody (PRA) was detected by using micro complement dependent lymphocytotoxicity test with Lambda cell tray. Donor and recipient HLA class Ⅰ typing was performed with special monoclonal tray and HLA class Ⅱ gene typing with micro sequence specific primers (Micro SSP). Results PRA positive rate in 17 recipients was 5.1% to 80% with an average of 37.9% ; patients with 0,1 or 2 mismatch (MM) of HLA crossreactive antigen group (CREGs) were 5(29%), 8 (47%) and 4 (24%) cases respectively according to the rule of CREGs matching and no cases had 3 6?MM, however the cases of 0, 1 or 2 MM were 1 (6%), 1 (6%) and 8 (47%) respectively by the standard of conventional HLA antigen matching and 7 (41%) cases had 3 4?MM. Only 3 patients developed acute rejection and were reversed by OKT3 treatment. Renal function returned normal in all patients. Conclusions The possibility of good matching was greatly enhanced by the CREGs matching. Good HLA matching plays an important role in reducing the incidence of acute rejection and in improving the survival of renal transplants.