配偶供肾移植后微嵌合体发生与急性排斥反应

Relationship between microchimerism and acute rejection after spouse donor kidney transplantation

背景:微嵌合作为移植物与受者之间的双相细胞移动的标志,在移植免疫耐受中的作用日益受到重视。目的:探讨夫妻生活与嵌合体的发生,与肾移植后急性排斥反应及其他相关性的研究。方法:将接受肾脏移植的女性受者(有过生育史的女性除外)分为丈夫活体供肾组、无关男性尸体供肾组,并设立接受妻子活体供肾的对照组。STR方法检测女性受者体内男性供者来源的Y染色体反映微嵌合体的存在,与急性排斥反应发生的关系,并比较配偶间供肾效果的差异。结果与结论:尽管配偶间供肾移植存在供者年龄偏大以及人类白细胞抗原错配率较高的因素,但与接受无关男性尸肾移植的女性受者相比,接受丈夫活体供肾移植的女性更易检测出微嵌合体,而且肾移植后恢复情况好,急性排斥反应发生率低。而与接受妻子供肾的丈夫相比,接受丈夫供肾的妻子肾移植效果好。说明夫妻间长期相处导致女性接受丈夫体液的机会多,由此产生免疫耐受对于肾移植后人/肾的相容性好,急性排斥反应小。

BACKGROUND： Microchimerism as the sign of biphasic cell migration between the graft and the recipient has attracted more and more attention in transplantation tolerance. OBJECTIVE： To investigate the relationship between spousal life and occurrence of chimerism and the acute rejection after renal transplantation. METHODS： The female kidney transplant recipients （except the females have reproductive history） were divided into two groups： husband living kidney donation group and unrelated male cadaver kidney donation group. Control group was set for husband recipients who received the living kidney donation of their wives. The Y chromosome from the male donor in the female recipients was detected by STR to reflect the presence of microchimerism as well as the correlation with acute rejection. The effect of the donor kidney was compared between spouses. RESULTS AND CONCLUSION： Though there was a higher rate of human leukocyte antigen mismatches and elder donor age between spouses, the female recipients received husband living kidney donation detected the microchimerism more easily when compared with the female recipients received unrelated male cadaver kidney donation, and female recipients received husband living kidney donation could recover quickly with lower acute rejection rate. Compared with the husband received wife living kidney donation, the wife received husband living kidney donation had better effect after renal transplantation. It indicates that long terms of spousal life leads to more opportunity of accepting her husband’s humoral, so result in the immune tolerance with good kidney compatibility after renal transplantation and low acute rejection rates.