供者特异性抗体对肾移植患者肾功能的影响

The influence of donor specific antibody on renal function after renal transplantation

目的 探讨供者特异性抗体（DSA）与移植肾急性排斥反应以及肾功能恢复的关系.方法 对2010年6月至2014年5月在烟台毓璜顶医院接受肾移植的459例受者中,用Luminex 200系统法检测DSA抗体.对肾移植受者进行术后2～6个月随访,共检测出46例群体反应性抗体≥10％,在这些致敏受者中男20例,女26例,年龄17 ～ 72岁,平均年龄45岁.46例致敏肾移植受者中18例体内检测出DSA.结果 与DSA阴性患者比较,DSA阳性患者急性排斥反应发生率高（33.3％比7.1％）,差异有统计学意义（P＜0.05）;移植肾功能延迟恢复发生率也较高（27.7％比3.6％,P＜0.01）;6个月后在DSA阳性组中,发生4例移植物丢失,而DSA阴性组只有1例发生移植肾失功,差异有统计学意义（P＜0.05）.两组均有1例患者死亡,患者存活率差异无统计学意义（P＞0.05）.结论 DSA的存在与排斥反应以及移植肾功恢复明显相关.对于DSA阳性的高危肾移植患者,术后应定期监测DSA,及时调整免疫抑制方案.

Objective To investigate the significance of donor specific antibody （DSA） on acute renal rejection and renal function.Methods DSA was detected with Luminex200 in 459 renal transplant patients who were operated in Yaitai Yuhuangding Hospital from June 2010 to April 2014.Penal reactive antibody ≥10％ was found in 46 patients,including 20 males and 26 females,the average age was 45 years,and DSA was positive in 18 patients.Results There was significant difference in acute renal rejection,delayed renal function and graft dysfunction between DSA-positive group and DSA-negative group,but there was no signaficent difference in patient survival between the two groups.Conclusion DSA played a great role in acute renal rejection and renal function.The detection of DSA in time was the effective method to predict acute rejection after renal transplantation.