人白细胞抗原交叉反应组配型在肾移植中的应用

Application of human leukocyte antigen and cross-reactive group matching in clinical renal transplantation

目的 探讨人白细胞抗原 (HLA)交叉反应组 (CREGs)配型原则在临床肾移植中的应用及意义。 方法 3 12例肾移植患者分为两组 ,一组按传统配型原则错配 2个以上位点并采用CREGs配型原则选择供受者 ,149例 ;另一组为同期按传统配型原则错配 0～ 2个位点者 ,163例。比较两组移植肾 1年存活率及术后 1个月内急性排斥发生率。 结果 按CREGs配型原则 ,供受者HLA Ⅰ类抗原 0、1、2错配百分比分别为 16.7%、41.6%和 3 4.2 % ,传统配型者分别为 6.7%、2 1.5 %和 71.8%。CREGs 0、1错配组相配率显著高于传统配型对应组 (P <0 .0 1)。术后 1个月急性排斥反应发生率各对应组间相比差异无显著性意义 (P >0 .0 5 ) ,但CREGs 0错配组明显低于A、B 2错配组 (P <0 .0 5 )。移植肾 1年存活率各对应组间差异无显著性意义 (P >0 .0 5 ) ,但CREGs 0错配组明显高于A、B 2错配组 (P <0 .0 5 )。 结论 采用CREGs配型原则选择供受者 ,可以获得满意的移植肾 1年存活率 ,并不增加术后排斥反应发生率 。

Objective To investigate the application and significance of human leukocyte antigen (HLA) and cross reactive groups(CREGs) matching in clinical renal transplantation. Methods A total of 312 cases of kidney transplantation were divided into two groups.In one group of 149 cases of kidney transplantations,ClassⅠCREGs matching criteria were applied instead of conventional HLA A,B matching which had two A,B mismatches(MM).In the other group of 163 cases of kidney transplantation there were A,B 0～2MM by the conventional criteria.The graft survival rate at 1 year and incidence of acute rejection within 1 month after transplantation were compared between the 2 groups. Results The percentages of HLA Ⅰ antigens 0,1,2MM were 16.7%,41.6% and 34.2% by CREGs matching criteria,and were 6.7 %,21.5% and 71.8% by conventional matching criteria.The matching rates in CREGs 0,1MM group were significantly higher than those in corresponding conventional matching group ( P <0.01).There were no significant differences in incidence of acute rejection at 1 month after transplantation between the corresponding groups ( P >0.05);however,the incidence rate of CREGs 0MM group was obviously lower than that of A,B 2MM group ( P < 0.05 ).The differences of 1 year graft survival rates between the corresponding groups were not statistically significant ( P > 0.05 ),but the rate of CREGs 0MM group was obviously higher than that of A,B 2MM group ( P <0.05). Conclusions Increased survival rate and reduced acute rejection can be achieved by CREGs matching criteria.Moreover, using CREGs matching criteria would significantly increase the chance of recipients to receive well matched kidneys.