亲属肾移植术后肾功能与PRA相关性研究

Correlation between PRA Positive and Declining Renal Function after Living-Related Kidney Transplantation

目的研究亲属肾移植受者体内群体反应性抗体（PRA）对移植肾功能及移植肾存活时间的影响。方法自2006年4月～2010年10月，观察做活体亲属肾移植的患者，追踪其肾功能状况并检测群体反应性抗体。共有患者250例，其中男性188例，女性62例，年龄10~58岁。根据供受关系，将患者分为3组：①父母给子女供肾组；②子女给父母供肾组；③兄弟姐妹间供肾组。对移植后受者检测其PRA，并观察其肌酐、尿素氮指标，跟踪观察其移植肾功能状态。结果父母给予女供肾组，共125例，有38例患者出现肾功能下降，占30．4％；其中9例PRA阳性。子女给父母供肾组，共13例，有1例出现肾功能下降，占7．7％，且此例为第2次肾移植患者，另有1例PRA阳性，肾功能正常。在兄弟姐妹问供肾组112例中，有13例出现肾功能下降，占11．6％，其中3例PRA阳性。以上患者PRA阴性者共237例，阴性率94．8％（237／250），其中肾功能下降者40例，占PRA阴性者的16．88％（40／237）；PRA阳性患者共13例，阳性率5．2％（13／250）；其中肾功能下降者12例，占PRA阳性者的92．31％（12／13）。PRA阴性与阳性二者间肾功能下降比率差异有统计学显著性意义（16．88％VS92．31％，P〈0．01）。父母供肾给子女组，肾功能下降比率30．4％，高于子女给父母供肾组的7．7％和兄弟姐妹间供肾组的11．6％。结论亲属活体肾移植PRA产生的几率较低，肾移植术后PRA的产生，直接影响移植肾功能，亲属问活体肾移植肾功能下降主要发生在父母供肾给子女组。

Objective To investigate whether the PRA positivity after living-related kidney transplantation is associated with declining renal function. Methods Atotal of 250 cases were collected from April 2006 to October 2010. There were 188 males and 62 females. They were divided into three groups based on donors relationship to recipients. They were ① par- ents＇ organs to children （125 cases） , ②children＇s organs to parents （13 cases） ,and ③ siblings＇ organs to siblings （112 ca- ses）. Follow-up observations were made of the PRA,serum creatine,BUN,and clinical renal function. Results Thirty-eight patients in group ① showed declining renal function and 9 of them were PRA positive. One patient in group ② showed decli- ning renal function with negative PRA and one patient showed positive PRA without declining renal function. Thirteen pa- tients in group ③ showed declining renal function and 3 of them were PRA positive. Of 250 cases, 237 patients were PRA negative,the negative rate being 94.8% （237/250）, among whom 40 showed declining renal function, accounting for 16.88 % （40/237）. 13 patients were PRA positive, the positive rate being 5.2 % （13/250）, among whom 12 showed decli- ning renal function,accounting for 92.31% （12/13）. 16.88% of PRA negative patients showed declining renal failure versus 92.31% of PRA positive patients （P〈0.01）. Group （D showed a higher declining renal function rare of 30.4% （38/125）, compared with the rates of 7.7% （1/13） and 11.6% （13/112） in group ② and ③. Conclusion Living-related kidney trans- plantation resulted in a low PRA positive rate. The PRA positivity is directly associated with declining renal function. A higher rate of renal function decline appears in the group of parents as donors.