异体手移植的组织配型初步探讨

Study of tissue typing in human hand allograft.

目的 研究组织配型在异体肢体移植中的意义和潜力。方法 对准备接受异体手移植的10位单手或双手缺失的患者和潜在的供者进行ABO血型和Rh血型、群体反应抗体(PRA)检测及混合淋巴细胞培养试验,采用聚合酶链反应(PCR)方法测定人类白细胞抗原(HLA)。结果 为其中2位患者各找到1名ABO血型(A-A、O-O)、Rh血型相符,PRA和混合淋巴细胞培养试验均为阴性,人类白细胞抗原(HLA)配型半相合的供者。手术后联合应用免疫抑制剂,移植手顺利成活,免疫监测和皮肤活检证实无排斥反应发生。结论 理想的组织配型是避免异体手移植发生排斥反应的前提条件,异体手移植理想的组织配型条件是ABO血型与Rh血型相符、淋巴细胞毒性交叉配合试验阴性,PRA水平越低、HLA位点配合的越多是提高异体手移植的成功率和存活率的保证。

Objective To find donors with ideal tissue compatibility and study the potentiality of tissue typing in human hand allotransplantation. Methods ABO, Rh and PRA were studied in ten transplant candidates with one or two-hand defect and potential donors. HLA was confirmed by PCR in these people, and mixed leukocyte culture(MLC) was performed to determine T-cell alloreactivity between donor and recipient. After the surgery, im-munosuppressants, which included antithymocyte globins, FK506, mycophenolic acid and prednisone, were used. Results Two patients were matched respectively to two ABO- and Rh-compatible, HLA-half compatible brain-dead donors, with negative PRA and MLC. The postoperative course was uneventful. At 10 months after surgery the two hands recovered well and assaying of C-eactive protein, immunoglobins, CD25 and HLA-DR in the blood and skin biopsy confirmed no rejection occurred. Conclusion Ideal tissue compatibility is the prerequisite for hand allografting to avoid graft rejection. The criteria of tissue typing was still to be defined, but ABO and Rh should be compatible, low PRA and MLC and high HLA-compatibility were beneficial.