肾移植供受体HLA错配与术后并发恶性肿瘤的关系

Relation between donor-recipient HLA mismatching and combined malignant tumor after renal transplantation

目的：研究肾移植供受体人类白细胞抗原（HLA）错配与术后并发恶性肿瘤的关系。方法对1993年至2009年在首都医科大学附属北京友谊医院泌尿科行肾移植手术5年以上，且有完整的供受体HLA分型的1021例患者的临床资料进行研究。1021例肾移植术后患者中，非肿瘤患者928例，恶性肿瘤患者93例。收集供受者HLA-A、B和DR 3个位点共6个抗原的错配情况，分析供受体HLA错配数与肾移植术后发生恶性肿瘤的关系，以及不同性别肾移植患者的供受体HLA错配数与术后发生恶性肿瘤的关系。结果1021例患者中9.11％（93/1021）发生恶性肿瘤。HLA错配0～1，2、3、4、5和6个抗原的患者恶性肿瘤发生率分别为14％、13％、14％、6％、3％和4％。HLA半相合以上（HLA错配0～3个）患者的恶性肿瘤发生率明显高于HLA半相合以下（HLA错配4～6个）患者（14％比5％，χ2＝24.11，P＜0.005）。恶性肿瘤患者中，HLA半相合以上的男性和女性患者分别为12例和54例；HLA半相合以下的男性和女性患者分别为12例和15例，HLA半相合以上患者中女性患者所占比例高于男性患者（χ2＝5.60，P＜0.025）。结论 HLA配错数越低的肾移植患者特别是女性患者，其恶性肿瘤发生率越高。

Objective To study the relation between donor-recipient human leukocyte antigen （HLA）mismatching and combined malignant tumors after renal transplantation. Methods Clinical data of 1 021 patients who received renal transplantation from 1993 to 2009 in Department of Urology of Beijing Friendship Hospital of Affiliated Capital University of Medical Sciences over 5 years and had complete HLA typing were analyzed. In the 1 021 patients after renal transplantation,928 cases were non-tumor patients and 93 cases were malignant tumor patients. The mismatching data of 3 locus （HLA-A,B and DR）with a total of 6 antigens of the donors and recipients were collected. The relation between donor-recipient HLA mismatching number and postoperative combined malignant tumors was analyzed. And that between genders was also analyzed. Results Malignant tumors occurred in 9.11% （93/1 021）of the patients. The malignant tumor incidences of patients with HLA mismatch of 0-1,2,3,4,5 and 6 antigens were 14%,13%,14%,6%, 3% and 4%respectively. Patients with HLA over half-matched （0-3 antigens mismatch）had higher incidence of malignant tumors compared with that in patients with HLA less than half matched （4-6 antigens mismatch） （14% vs. 5%;χ2 =24.11,P〈0.005）. In the malignant tumor patients of0-3 antigens mismatch,12 cases were males and 54 cases were females. In the patients of 4-6 antigens mismatch,12 cases were males and 15 cases were females. The proportion of female patients of 0-3 antigens mismatch was higher than that of male patients （χ2 =5.60,P〈0.025）. Conclusions For the renal transplant patients,especially female patients,＆amp;nbsp;the lower the HLA mismatching number is,the higher the malignant tumor incidence is.