致敏受者肾移植术后疗效观察

Effectiveness of kidney transplantation in sensitized recipients

目的 探讨致敏受者经严格的HLA配型及HLA交叉反应组配型后行肾移植的效果。方法 对 63例移植前群体反应性抗体 (PRA)水平较高的患者进行严格的供、受者HLA配型筛选 ,并按照美国国立器官分配中心 (UNOS)制定的HLA交叉反应组 (CREGs)配型原则进行供、受者配型筛选 ,按常规肾移植方法进行移植 ,术前未行血浆置换。结果 63例患者 ,44例术后 1周内移植肾功能恢复正常 ;1 0例术后出现移植肾急性排斥反应 ,经静脉滴注单克隆抗体OKT3 ,7例肾功能恢复正常 ,3例切除移植肾 ;9例术后发生移植肾功能延迟恢复 ,8例于术后 2周至 2个月移植肾功能逐渐恢复正常 ;死亡 2例 ;总急性排斥反应发生率及总移植肾功能延迟恢复发生率分别为 1 5 .9%和 1 4 .3 % ;按CREGs配型原则 ,供、受者 0、1、2个位点错配分别为 1 1例 (1 7.5 % )、39例 (61 .9% )和 1 3例(2 0 .6 % ) ,明显高于传统HLA抗原配型结果。结论 致敏受者必须严格按照HLA配型及HLA交叉反应组配型原则进行供、受者的筛选 ,这对减少移植肾排斥反应、提高移植肾的存活率有重要意义。

Objective To investigate the effectivess of kidney transplantation in sensitized recipients receiving human leukocyte antigen (HLA) and crossreactive groups (CREGs) matching. Methods Recipients' panel reactive antibody (PRA) was detected by using micro complement dependent lymphocytotoxicity test with Lambda cell tray. Donors' and recipients' HLA class Ⅰ typing was performed with special monoclonal tray and HLA class Ⅱ gene typing with micro sequence specific primers (Micro SSP). Results In the 63 recipients PRA positive rate was 12?% ～ 96?% (Mean 51.7?% ); Kidney function recovered in 44 cases in one week. Among the 10 cases of acute rejection (AR),7 were reversed by OKT3 treatment and 3 were failure.Nine cases were subjected to delayed graft function (DGF) and 8 returned normal function in 2 weeks to 2 monthes.The successful rate was 93.7?% (59/63) and mortality rate was 3.2?% (2/63). The incidence of AR and DGF was 15.9?% and 14.3?% respectively. According to the rule of CREGs matching,patients with 0,1 or 2 mismatching (MM) of HLA CREGs were 11 ( 17.5?%) ,29 ( 61.9?% ) and 13 ( 20.6?% ) cases respectively.Conclusion The rule of HLA matching and HLA CREGs must be performed strictly in sensitized recipients and it is very important to reduce allograft acute rejection and enhance the survival rate of allograft.