氨基酸残基配型在致敏受者肾移植中的应用

HLA-amino acid residue matching for sensitized recipients in kidney transplantation

目的：探讨人类白细胞抗原(HLA)-氨基酸残基配型(Res M)标准在致敏患者中的应用。方法：根据HLA分子结构的氨基酸残基不同，将HLA I类抗原分成10个组，Ⅱ类抗原分成7个组，确定Res M配型标准；并与标准HLA抗原配型(Ag M)进行比较。回顾性分析Res M对102例致敏患者早期肾功能、急性排斥、术后抗HLA-IgG抗体水平及人／肾存活率的影响。结果：应用Res M标准，可明显提高供受者相配概率，0 MM受者由AgM组1．89％提高到Res M组18．87％(P<0．001)，0～1MM组受者由9．43％提高到60．37％(P<0．001)：临床研究结果显示：残基相配的移植肾短期存活率和1、3年长期存活率接近HLA抗原相配水平；与错配组相比，早期移植肾功能延迟恢复发生率、急性排斥反应发生率显著减少，术后抗HLA-IgG抗体水平升高或出现抗供者特异性抗体发生率明显降低，1、3年移植肾存活率明显提高。结论：HLA—Res M，可大幅度增加供受者的相配概率，显著降低术后的致敏性，适合在致敏患者肾移植中应用。

Objective: To explore the applied value of HLA amino acid residue matching (Res M) for sensitized recipients in kidney transplantation. Methodology: Based on the difference of the amino acid residue, we presented a new Res M according to 10 groups of amino acid residue for class I antigen and 7 groups of DR/DQ for class Ⅱ antigen, and compared them with HLA six-antigen match program (Ag M ). The influence of Res M on early renal function, acute rejection episodes, increasing anti-HLA-IgG antibody level of recipients after transplantation, and 1,3 year recipient/graft survival rate were retrospectively analyzed in 106 cases of sensitized recipients in kidney transplantation. Results: The rate of Res- matched transplants greatly increased. The rate of 0 mismatch (MM) recipients increased from 1.89% by Ag M to 18.87% by Res M, and that of 0-1 MM transplants from 9.43% to 60.37%. The clinical studies showed that 1-3 year recipient /graft survival rate with 0-1 Res-MM was similar to that with 0-2 Ag MM. Compared with 3-4 Res-MM, the rate of delay graft function obviously decreased from 75.0% to37.5%, the acute rejection episodes rate decreased from 75.0% to 23.43%, the rate of increasing anti-HLA-IgG antibody decreased from 75% to 32.8%, and 1,3 year graft survival rate increased 31.25%, 42.2% in recipients with 0-1 Res-MM. Conclusions: The Res M can greatly increase the rate of Res-matched transplants, minimize the sensitization response to allograft and be suitable to the clinical application for sensitized recipients in renal transplantation.