移植肾长期存活受者体内人白细胞抗原抗体对移植肾功能的影响

Effect of Antibodies of Human Leukocyte Antigen on Graft Survival in Long-Term Survived Renal Recipients with Functional Grafts

目的:分析移植肾长期存活的受者体内人白细胞抗原(human leukocyte antigen,HLA)抗体的变化及其对移植肾功能的影响。方法:采用酶联免疫吸附法对92例接受环孢霉素等为基础免疫治疗方案的肾移植受者进行HLA抗体检测,观察HLA抗体对移植肾长期存活的影响。结果:92例患者中,移植前检出HLA-Ⅰ类抗体27例,HLA-Ⅱ类抗体16例;移植10年后检出HLA-Ⅰ类抗体12例,HLA-Ⅱ类抗体18例。移植肾长期存活患者的HLA-Ⅰ类和HLA-Ⅱ类抗体均为移植后新出现的HLA抗体。根据移植10年后HLA抗体检测的结果,将移植肾长期存活的肾移植受者分为HLA抗体阳性组(n=23)和阴性组(n=69),两组患者的估计肾小球滤过率(eGFR)分别为(66.52±14.52)mL/(min.1.73 m2)和(69.09±25.54)mL/(min.1.73 m2),组间差异无统计学意义(P>0.05)。92例患者中,有3例(3.26%)检出供者特异性抗体,检出率显著低于普通肾移植人群。结论:肾移植术后移植肾长期存活的患者体内的HLA抗体均为移植后产生,移植前的致敏抗体均已消失。移植肾长期存活的肾移植患者体内HLA抗体存在与否对移植肾功能的影响低微。

Objective：To investigate the effect of antibodies of human leukocyte antigen（HLA） on graft survival in long-term survived renal recipients with functional grafts. Methods：A total of 92 long-term survived renal recipients with functional grafts who were treated with eyelosporine-based triple maintenance drug therapy have been enrolled. Post-transplant serum samples from them were screened for anti-HLA antibodies. Results： Before transplantation, HLA-I antibodies were found in 27 patients and HLA-II antibodies were found in 16 patients . However, HLA-I antibodies were found in 12 patients and HLA-II antibod- ies were found in 18 patients at present. Moreover, all of these antibodies were different from those found before transplanta- tion. In these renal recipients with functional renal grafts, the estimated glomeru[ar filtration rates （eGFR） were （66. 52 ± 14. 516） mL/（min · 1.73 m2 ） and （69.09 ± 25. 542） mL/（min · 1.73 m2） in HLA antibody-positive group（n = 23） and HLA antibody-negative group（n = 69）, and the difference between the two groups was not significant（P〉0.05）. Among the 92 re- cipients, 3 patients（3.26G） had donor specific anti-HLA antibodies （DSA）. The frequency of DSA in this study is lower than that of normal kidney recipients. Conclusions： HLA antibodies in long-term renal grafts are all de novo, not pre-transplant sen- sitized ones. The status of HLA antibodies has little impact on the function of present renal grafts in long-term survived recipi- ents.