高度致敏肾移植受者的HLA抗体公共表位分析

The analysis of public epitope specificity of HLA alloantibodies in highly sensitized renal transplantation recipients

目的 :探讨对高度致敏肾移植受者进行人类白细胞抗原 (HLA)特异性抗体的公共表位分析的临床意义。方法 :对 2 4例高度致敏受者 (HLA I类抗体PRA >5 0 %)作群体反应性抗体 (PRA)的连续监测 ,并做抗体特异性鉴定和抗体公共表位分析。结果 :2 4例高度致敏受者中 2 1例 (87.5 %)具有公共表位抗体 ,抗体公共表位分析比抗体特异性鉴定能更准确反映抗体谱。 16例高度致敏患者根据抗体公共表位分析结果找到HLA相容的供肾 ,成功地进行了肾移植术。结论 :对少数高频率高免疫原性氨基酸残基公共表位的致敏是高敏受者致敏的主要原因。高度致敏受者的抗体公共表位分析能有效指导HLA配型。

Purpose:To explore the public epitope specificity analysis of human leucocyte antigen (HLA) alloantibodies in highly sensitized renal transplantation recipients. Method:The panel reactive antibody (PRA) levels of HLA alloantibodies in 24 highly sensitized recipients (HLA-class I antibody PRA>50%) were monitored continually, and the antibody specificities and public epitope specificities were also analyzed. Results:Public epitope specificities of HLA alloantibodies could be identified in 87.5 %(21/24) of the patients. Analysis of public epitopes can reflect antibody spectrum more accurately than antibody specificity analysis. 16 highly sensitized recipients accepted successful kidney transplantation with compatible donor HLA antigens on the basis of antibody public epitope analysis. Conclusions:Most anti-HLA antibodies of highly sensitized recipients are directed against a small number of high frequency public epitopes of amino acid residues with high immunogenicity. Analysis of public epitopes of HLA antibodies can instruct HLA matching effectively in highly sensitized recipients.