人类白细胞抗原配型在高致敏受者肾移植中应用

Application of Human Leukocyte Antigen Matching in Highly Sensitized Recipients of Renal Allografts

目的 探讨人类白细胞抗原 (HLA)交叉反应组 (CREGs)配型原则在肾移植高致敏受者中的应用及意义。方法 应用莱姆德细胞板通过补体依赖微量淋巴毒性试验检测受者的群体反应性抗体 (PRA) ;应用单抗干板进行供受者HLA -Ⅰ类抗原分型 ;应用微量序列特异性引物 (Micro -SSP)进行HLA -Ⅱ类基因分型 ;对 14例高致敏肾移植受者采用交叉反应组配型原则选择供者 ,观察其供受者相配情况及移植效果。结果 按交叉反应组配型原则 ,供受者HLACREGs +DR 0 ,1和 2错配 (MM)分别为 4例( 2 8% )、6例 ( 4 4% )、4例 ( 2 8% ) ,无 3～ 6错配 ;而按传统的HLA -A ,B ,DR抗原配型原则 ,其 0 ,1,2 ,3和 4MM ,分别为 1例 ( 7% )、3例 ( 2 1% )、5例 ( 3 6% )和 5例 ( 3 6% ) ,无 4～ 6MM者 ,其中 0～ 1错配仅有 4例。肾移植术后仅有 4例发生急性排斥反应 ,经OKT3治疗逆转 ,所有受者术后肾功能均恢复正常。结论 良好的HLACREGs配型 ,可以显著提高供受者相配率 ,对减少致敏受者的排斥反应 ,提高移植肾存活率具有重要的意义。

Objective To investigate the application and significance of human leukocyte antigen(HLA) and cross-reactive antigen groups(CREGs) matching in highly sensitized recipients of renal allografts.Methods Recipient's panel reactive antibody(PRA)was detected by using complement dependent-micro lymphocytotoxicity test with lambda cell tray.Donor and recipient HLA classⅠtyping was performed with special monoclonal tray and HLA classⅡgene typing with microsequence specific primers(Micro-SSP). Fourteen highly sensitized patients with PRA positive(PRA>40%)were observed in HLA CREGs matching and outcome of post-transplantation.Results Patients with 0,1,2 or 3 mismatching(MM) of HLA CREGs+DR were 4(28%), 6(44%)and 4(28%)cases respectively according to the the rule of CREGs matching and no case had 3～6 MM.However the cases of 0,1,2,3 and 4 MM were 1(7%),3(21%),5(36%)and 5(36%)respectively by the standard of conventional HLA antigen matching,without 4～6 MM and only 4 cases had shared 0～1MM.Only 9 patients were developed into acute rejection, and were reversed by OKT3 treatment after transplantation.Renal function was returned to normal in all patients.Conclusions Using CREGs matching criteria would significantly increase the chance of recipients to receive well-matched kidney and provide more chance for waiting recipients.Suitable HLA matching could play an important role in reducing the incidence of acute rejection and improving graft survival in sensitized patients.