供体特异性输血与嵌合体发生及肾移植急性排斥反应的关系

Relationship between chimerism and donor-specific transfusion and acute kidney transplantion rejection

目的 :研究供体特异性输血 (DST)患者末梢血中嵌合体的发生及其与肾移植急性排斥反应的关系。方法 :肾移植患者 6 0例 ,分为 :A组 ,未行 DST的尸体肾移植 35例 (2 or 3HL A- mism atched) ;B组 ,未行 DST的活体肾移植 3例 ,HL A配型各位点无错配 ;C组 ,术前行 DST的活体肾移植 2 2例 (1 or 2 HL A- mism atched) ,利用 PCR- SSP法检测患者末梢血中的 HL A- DRB1基因。结果 :A组 1 2例 (34.3% )、B组 3例 (1 0 0 % )、C组 1 9例(86 .3% )发现了供体的 HL A- DRB1基因 ,证实有嵌合体发生。在 34例有嵌合体发生的病例中 1 4例 (4 1 .2 % )、2 6例无嵌合体存在的病例中有 1 0例 (38.5 % )发生过急性排斥反应 ,但两组间比较差异无显著性 (P>0 .0 5 ) ,同时排斥反应发生的频率、次数比较差异也无显著性 (P>0 .0 5 )。另外 ,C组病例中嵌合体现象消失 ,PCR- SSP检测转为阴性时未见排斥反应病例发生。结论 :DST有利于促进嵌合体的形成 ,嵌合体现象与急性排斥反应间无相关性 。

Objective To study the relationship between chimerism of peripheral blood and donor specific transfusion (DST) and acute kidney transplantion rejection. Methods The subjects were divided into 3 groups: group A, 35 subjects with corpse donor kidney transplantation who did not undertake DST before operation (2 or 3 HLA mismatched); group B, 3 subjects with live donor kidney transplantation who did not undertake DST before operation (none was HLA mismatched); group C, 22 subjects who undertook DST before operation (1 or 2 HLA mismatched). PCR SSP was used to check the HLA DRB1 gene in peripheral blood. Results 12 subjects (34 3%) in group A, 3 subjects (100%) group B and 19 subjects (86 3%) in group C were found donor HLA DRB1 gene. Chimerism was confirmed. 41 2% (14/34) subjects with chimerism and 38 5% (10/26) subjects without chimerism were found acute rejection,but there was no significant difference between two groups ( P >0 05), as well as the frequency and times of rejction. Moreover, chimerism disppeared in all cases in group C and there was no rejection.Conclusion DST can lengthen the survival of the donor kidney by improving the formation of micro chimerism. There is no accountable relationship between the disappearance of chimerism and acute rejection.