采用流式细胞微珠法检测肾移植受者体内供者特异性抗体39例

Detection of donor specific antibodies using LuminexTM single antigen beads in living-relative renal transplantation： areportof39 cases

目的应用流式细胞微珠法检测肾移植受者供者特异性抗体（DSA），并探讨DSA阳性受者的HLA配型及移植物排斥反应发生情况。方法检测39例亲属肾移植受者移植前、后的DSA，检测供、受者HLA错配情况，记录受者移植后排斥反应的发生情况。分析DSA阳性及阴性受者的HLA错配及排斥反应的发生情况。结果39例共检测DSA313次，其中移植前78次，移植后235次，移植前出现DSA阳性的均暂缓手术。5例HLA无错配的受者移植后DSA均为阴性，34例HLA错配的受者移植后12例出现DSA阳性（35．3％，P〈0．05）。12例DSA阳性受者中，5例发生排斥反应（41．7％），其排斥反应发生率显著高于DSA阴性的移植受者（7．4％，P〈0．05）。发生排斥反应且DSA阳性受者的单抗原微珠免疫荧光强度均值为5723．9±1030．5，高于未发生排斥反应的DSA阳性者的2355．2±609．7（P〈0．05）。DSA阳性的受者治疗后，DSA免疫荧光强度有所下降。结论采用流式细胞微珠法动态监测DSA效果较好，有利于预测和及时防治肾移植后排斥反应。

Objective To analyze the clinical application of donor specific antibodies （DSAs） detected by Luminex single antigen beads, and evaluate the relationship between the presence of DSAs and renal acute rejection. Method Serum from living-relative renal recipients of 39 cases before and after transplantation was investigated using a Luminex single antigen assay. The relation between HLA mismatch and DSA development, and the impact of DSAs on renal acute rejection were analyzed. Result A total of 313 serum samples from 39 patients were tested, including 78 serum samples before transplantation and 235 after transplantation. Recipients positive for DSAs before transplantations were not included. Five recipients with no HLA mismatch did not develop DSAs. In contrast, 12 developed DSAs in 34 recipients with 0-4 HLA mismatch （35.30%, 12/34）. Among DSAs-positive recipients, 5 recipients developed acute rejection （41.7%, 5/12）, significantly higher than that in recipients without DSAs （7. 40%, 2/27）, P〈0. 05. Furthermore, the average MFI value of DSAs in DSAs-positive recipients with rejection was （5723.9 ± 1030. 5） MFI, significantly higher than that in DSAs-positive recipients without rejection （2355.2 ± 609. 7） MFI, P〈0. 05. The MFI values of DSAs were gradually decreased when the patients were properly treated. Conclusion HLA mismatch may increase the risk to develop DSAs. The development of DSAs leads to acute rejection. Therefore, dynamic monitoring of DSAs using Luminex single antigen beads may timely predict renal rejection.