抗人类白细胞抗原抗体对肾移植术后长期存活受者移植肾功能的影响

Effects of anti-HLA antibodies on renal function of long-term survival recipients after kidney transplantation

目的研究抗HLA抗体对肾移植术后长期存活受者移植肾功能的影响。方法回顾性分析1993至2006年于首都医科大学附属北京友谊医院行肾移植,并于2007年检测抗HLA抗体为阳性的143例受者临床资料。受者均于2010至2011年再次检测群体反应性抗体,观察肾功能和存活情况。结果 143例受者中,抗HLA-Ⅰ类抗体阳性13例,抗HLA-Ⅱ类抗体阳性107例,抗HLA-Ⅰ+Ⅱ类抗体阳性23例。截至2014年10月,上述3组抗体阳性受者中,移植肾失功和肾功能下降受者比例分别为61.5%(8/13)、42.0%(45/107)和87.0%(20/23)。3种类型抗体阳性受者发生肾功能异常比例差异具有统计学意义(χ2=14.3,P<0.05),抗HLA-Ⅱ类抗体阳性受者中肾功能异常比例低于抗HLA-Ⅰ+Ⅱ类抗体阳性受者,差异有统计学意义(χ2=15.3,P<0.017)。结论抗HLA-Ⅰ+Ⅱ类抗体对长期存活受者的移植肾功能影响大于抗HLA-Ⅱ类抗体。

Objective To study the effects of anti-HLA antibodies on the renal function of long-term survival recipients after kidney transplantation. Methods Clinical data of 143 renal transplant recipients who were treated with renal transplantation from 1993 to 2006 in Beijing Friendship Hospital affiliated to Capital Medical University were analyzed. All the recipients were anti-HLA antibodies positive when they got anti-HLA antibodies testing in 2007. From 2010 to 2011, the recipients got panel reactive antibody testing again, meanwhile, function and survival condition of renal allograft were observed. Results In the total of 143 recipients, 13 were class - Ⅰ anti-HLA antibodies positive, 107 were class-Ⅱ anti-HLA antibodies positive and 23 were class -Ⅰ＋Ⅱ anti-HLA antibodies positive. Up to October 2014, the ratio of renal allograft failure and function decline of the above-mentioned three antibodies positive groups was 61.5% （8/13） , 42.0% （45/107）and 87.0% （20/23） , respectively. The ratio of renal dysfunction of the three groups was statistically significant （χ^2 = 14.3, P 〈 0.05 ） , and the ratio of recipients between class- Ⅱ anti- HLA antibodies positive group and class -Ⅰ＋Ⅱ anti-HLA antibodies positive group was also statistically significant （χ^2 = 15.3, P 〈 0. 017）. Conclusion The effect of class -Ⅰ＋ Ⅱ anti-HLA antibodies on renal function of long-term survival recipients after kidney transplantation were more significant than those of class Ⅱ anti-HLA antibodies.