肾移植术后供者特异性抗体对移植肾近期效果的影响

Impact of donor-specific antibodies on kidney graft short-term survival

目的 评价肾移植术后供者特异性抗体 (Ds Ab)对移植肾近期效果的影响。方法 对2 0 0 1年 1月至 2 0 0 2年 7月间进行尸肾移植的 92例受者 ,使用酶联免疫吸附 (ELISA)法 ,检测受者血清中HLA抗体水平 ,随访 1年。结果 16例 (17.4 % )受者术后出现供者特异性抗体。抗体阳性组急性排斥发生率 (5 6 .3% )高于抗体阴性组 (11.9% ) ,P =0 .0 0 0 ;移植肾功能延迟恢复的发生率(12 .5 % )与抗体阴性组 (9.2 % )比较 ,差异无显著性 ,P =0 .10 2 ;供者特异性抗体阳性组受者发生急性排斥后 ,移植肾肌酐水平高于抗体阴性组或无急性排斥组。结论 供者特异性抗体与肾移植术后急性排斥有关 ,可能影响近期移植肾功能。

Objective To evaluate the clinical relevance of donor-specific antibodies (Ds-Abs) and allograft short-term survival. Methods Pre- and post-transplant sera of 92 cadaver kidney recipients who were followed-up for one year after transplantation were tested by ELISA for anti-HLA antibodies from 2001.1 to 2002.7 . Results 16 ( 17.4?% ) resulted positive for Ds-Abs production among 92 patients. Nine of 16 ( 56.3?% ) Ds-Abs positive patients suffered acute rejections vs. only 9 of 76 ( 11.9?% ) Ds-Abs negative patients ( P = 0.000 ). Correlating delayed graft function (DGF) to Ds-Abs production, 2 of 16 ( 12.5?% ) Ds-Abs positive recipients experienced DGF vs. 7 of 76 ( 9.2?% ) Ds-Abs negative recipients ( P = 0.102 ). A worse graft function was evidenced in Ds-Abs positive subjects with acute rejection episodes than in those who had acute rejection but did not produce Ds-Abs or no rejection but produced Ds-Abs. Conclusion Donor-specific antibodies play an important role in acute rejection episodes after kidney transplantation. When comparing with sera creatinine levels, a strong link between Ds-Abs positive and graft short-term outcome is further evidenced.