异体手移植的组织配型初步探讨

目的：研究组织配型在异体肢体移植中的意义和潜力。方法：对准备接受异体手移植的10位单手或双手缺失的患者和潜在的供者进行ABO血型和Rh血型、群体反应抗体（PRA）检测及混合淋巴细胞培养度,采用聚合酶链反应(PCR)方法测定人类白细胞抗原（HLA）。结果：为其中2位患者各找到1名ABO血型（A-A、O-O）、Rh血型相符,PRA和混合淋巴细胞培养试验均为阴性,人类白细胞抗原（HLA）配型半相合的供者。手术后联合应用免疫抑制剂,移植手顺利成活,免疫监测和皮肤活检证实无排斥反应发生。结论：理想的组织配型是避免异体手移植发生排斥反应的前提条件,异体手移植理想的组织配型条件是ABO血型与Rh血型相符、淋巴细胞毒性交叉配合试验阴性,PRA水平越低、HLA位点配合的越多是提高异体手移植的成功率和存活率的保证。     

同种异体肢体移植配型的初步探讨

目的 研究组织配型的同种异体肢体移植中的意义和潜力。方法 对准备接受同种异体手移植的10例单手或双手缺失准备接受异体手移植的患者和潜在的供者进行ABO血型和Rh血型、群体反应抗体（PRA）检测及混合淋巴细胞培养试验，采用聚合酶链反应（PCR）方法测定人类白细胞抗原（HLA）。结果 为其中2例患者各找到1名ABO血型（A-A、O-O）、Rh血型相符，PRA和混合淋巴细胞培养试验均为阴性，人类白细胞抗原（HLA）配型半相合的供者。手术后联合应用免疫抑制剂，移植手顺利成活，免疫监测和皮肤活检证实无排斥反应发生。结论 理想的组织配型是避免异体手移植发生排斥反应的前提条件；异体手移植理想的组织配型条件是ABO血型、Rh血型相符，淋巴细胞毒性交叉配合试验为阴性；PRA水平越低、HLA位点配合的越多，越能提高异体手移植的成功率和存活率。     

异体手移植的组织配型初步探讨

目的 研究组织配型在异体肢体移植中的意义和潜力。方法 对准备接受异体手移植的10位单手或双手缺失的患者和潜在的供者进行ABO血型和Rh血型、群体反应抗体(PRA)检测及混合淋巴细胞培养试验,采用聚合酶链反应(PCR)方法测定人类白细胞抗原(HLA)。结果 为其中2位患者各找到1名ABO血型(A-A、O-O)、Rh血型相符,PRA和混合淋巴细胞培养试验均为阴性,人类白细胞抗原(HLA)配型半相合的供者。手术后联合应用免疫抑制剂,移植手顺利成活,免疫监测和皮肤活检证实无排斥反应发生。结论 理想的组织配型是避免异体手移植发生排斥反应的前提条件,异体手移植理想的组织配型条件是ABO血型与Rh血型相符、淋巴细胞毒性交叉配合试验阴性,PRA水平越低、HLA位点配合的越多是提高异体手移植的成功率和存活率的保证。     

同种异体双手移植一例报告

目的 探讨同种异体双手移植重建肢体功能的可行性。方法 根据ABO血型、Rh血型、人类白细胞抗原（HLA）配型、群体反应性抗体（PRA）检测及淋巴细胞毒性交叉试验等，选择脑死亡作供体，移植的双手均在腕上5cm处。移植的具体操作基本与自体断肢再植相同。术前两天及术中、术后均联合应用免疫抑制剂。术后观察、排斥反应现象的发生和生命体征及移植的肢体血液循环。结果 术后经过顺利，未发生排斥反应现象。移植双手血液循环正常，生命体征平稳。术后10周时尺、桡骨接骨处骨痂生长明显。术后5个月时手部的温痛觉完全恢复。术后7个月时取出尺、桡骨的内固定物同时行肌腱粘连松解术。现患可完成洗脸、穿衣、叠被褥、持牙刷刷牙、拿勺吃饭、剥橘子、打电话、使用遥控器看电视，缓慢地系鞋带等日常生活动作。结论 在联合应用免疫抑制 剂的情况下，同种异体双手移植可以存活，而骨愈合和神经生长速度快于自体再植。     

移植免疫研究进展

近十年来，外科手术，移植免疫学，器官和细胞分离保存技术方面的迅速发展，有力地促进了临床移植医学的迅速发展。本文报告第十六次国际移植协会会议资料，将同种异体移植免疫学最新研究报告如下。一、移植免疫排斥反应1．超急性排斥反应：移植后几分钟至几小时内，宿主体内预先存在的抗体与供体组织抗原结合，激活补体，阻塞破坏血管，致使移植组织功能突然丧失。临床上主要应用供受体人白细胞抗原（HLA）和ABO血型交叉配型预防超急性排斥反应。2．急性排斥反应：外科手术和组织缺血损伤导致移植器官血管内膜上皮细胞表面粘附分子增加…     

异体手移植2例:中国广州经验

目的 探讨异体肢体移植重建肢体缺失的可行性。方法 筛选两例右手外伤性缺如病人,与供者行ABO、Rh血型、人类白细胞抗原(HLA)配型、群体反应性抗体(PRA)检测及淋巴细胞毒性交叉试验,以确定合适的两例脑死亡者作供者。供体上肢切取后用4℃UW器官保存液灌注、冰桶内保存、运输,随机选择其中一个肢体在再植前经8Cy X射线照射。移植手术包括桡骨、尺骨固定,吻合尺、桡动脉、尺、正中神经、头、贵要静脉,缝合除指浅屈肌腱外所有肌腱及皮肤。术后常规应用抗感染、抗凝、解痉药物,联合应用抗免疫排斥反应药物:(1)全身用药:抗胸腺细胞球蛋白(ATG)、FK506、霉酚酸、强的松;(2)局部用药:肤轻松软膏涂手。术后密切观察生命体征、移植手血循环、免疫学指标以及皮肤活检。术后进行心理治疗以及在康复理疗师指导下进行功能锻炼。结果 术后移植手血循环同自体离断再植术。其中一个患者血糖升高,应用胰岛素对症治疗得以控制。皮肤切口顺利愈合。Tinel征检查显示神经生长速度较快。术后7周移植手皮肤发生红色丘疹,系局部使用过多肤轻松软膏所致,经停用肤轻松软膏并用炉甘石洗剂擦洗后治愈。术后4个月移植手功能较好,感觉已恢复至手指末节,可以持物,肌电图显示鱼际肌已见动作电位。术后定期取活检证实无任何排斥反应迹象。     

高度致敏肾移植受者的HLA抗体公共表位分析

目的：探讨对高度致敏肾移植受体进行人类白细胞抗原（HLA）特异性抗体的公共表位分析的临床意义。方法：对24例高度致敏受者（HLA－I类抗体PRA＞50％），作群全反应性抗体（PRA）的连续监测，并做抗体特异性鉴定和抗体公共表位分析。结果：24例高度致敏受者中21例（87．5％）具有公共表位抗体，抗体公共表位分析比抗体特异性鉴定能更准确反映抗体谱，16例高度致敏患者根据抗体公共表位分析结果找到HLA相容的供肾，成功地进行了肾移植术，结论：对少数高频率高免疫原性氨基酸残基公共表位的致敏是高敏受者致敏的主要原因，高度 致敏受者的,抗体公共表位分析能有效指导HLA配型。     

人类白细胞抗原配型与群体反应性抗体检测在心脏移植中的应用进展

人类白细胞抗原(human leukocyte antigen,HLA)是介导移植物排斥反应的主要抗原.群体反应性抗体(panel reactive antibody,PRA)代表血液循环中抗HLA抗体.器官移植前的供、受者HLA配型和受者PRA检测已广泛开展.随着HLA配型、PRA检测与心脏移植关系研究的深入,它们在心脏移植中的临床价值日益受到重视,其具体应用策略也不断发展.现从HLA分型方法与配型策略、HLA配型的临床意义、HLA配型时机选择、PRA升高的原因和机制、PRA检测的临床意义和致敏患者的处理等6个方面进行综述.     

同种异体肾移植的HLA配型效果观察

目的：探讨同种异体肾移植的HLA配型效果.方法：比较同种异体肾移植中采用传统HLA配型方法与CREG配型方法的移植状况;对比HLA配型组和未配型组1年移植效果的不同.结果：HLA抗原出现频率较高的有HLA-A2、A11、A24、B60（40）、B13、DR15、DR51、DR52、DR53、DR 4.根据HLA 6位点相配原则,0～6个位点错配（mismatch,MM）所占比例分别为0.78%、1.56%、5.06%、10.12%、27.63%、29.96%和24.9%;而采用交叉组间配型原则（CREGs）,0～6位点错配率分别为3.89%、6.23%、17.51%、33.85%、19.84%、13.23%、5.45%.结论：具有某些HLA位点的受者相对来说有更多的获得良好HLA配型的机会;CREGs配型原则明显提高了供、受者间的相配率,但移植效果仍有争议.     

同种异体骨移植免疫学

１８８０年Ｍａｃｅｗｅｎ首先施行了人类同种异体骨移植术,本世纪四十年代末建立了骨库,使同种异体骨移植的临床应用更为安全可行,骨移植已成为仅次于输血最常用的移植术。同种异体骨移植与实质脏器移植有所不同,诱发的宿主免疫排异反应一般不引起危及生命的严重后果,但免疫排异反应往往干扰移植骨愈合,影响治疗效果。１　同种异体骨关节移植抗原骨骼中的矿物质不具有抗原性,胶原和非胶原蛋白仅是弱抗原,同种异体骨移植的抗原刺激主要来自其细胞膜表面组织相容性抗原（ＭＨＣ）。ＭＨＣ抗原分为两大类,Ⅰ类抗原在人类为ＨＬＡ－Ａ…     

Acute Antibody-mediated Rejection Possibly Due to Anti–human Leukocyte Antigen DQB1 Antibodies after Renal Transplantation – Case Report

A 61-year-old Japanese woman, who had undergone hemodialysis because of chronic glomerulonephritis, received a living renal transplant from her ABO blood type–compatible spouse. HLA typing of A, B and DRB showed 3/6 mismatches. Complement-dependent cytotoxicity crossmatches, HLA antibody screening with the use of flow panel reactive antibody (PRA), and flow cytometry crossmatches (FCXM) were all negative. Tacrolimus, mycophenolate mofetil, methylprednisolone (MP), and basiliximab induction were used as the standard immunosuppressive therapy. After renal transplantation, her serum creatinine level favorably decreased, but urine output was not sufficiently obtained, contrary to our expectations. Doppler sonography revealed disappearance of diastolic arterial flow on postoperative day 2. The episode biopsy showed acute antibody-mediated rejection (AMR) based on the current Banff classification, although FCXM and flow PRA were still negative. To determine the cause of acute AMR, we expanded the HLA typing at high resolution levels to Cw, DQB1, and DPB1. Retrospective analysis of perioperative sera demonstrated the presence of low levels of donor-specific HLA IgG and moderate levels of IgM antibody against DQB1 before transplantation. There was an elevation of IgM antibody at the time of rejection, whereas IgG antibody showed no remarkable change. AMR was successfully treated with plasma exchange, low-dose intravenous immunoglobulin, high-dose intravenous MP pulse, and rituximab.     

Impact of selected factors on early graft function in patients after renal transplantation

Transplantation is the best treatment for end-stage renal diseases. For transplantologists, it is most important to know the factors that worsen graft survival prognosis. The aim of the study was to investigate factors predictive of graft loss and shortened graft survival. We retrospectively reviewed 442 renal transplant patients between 1990 and 1995 in two Szczecin units, all of whom received a triple-drug immunosuppressive regimen. One hundred thirty patients showed graft disorders such as delayed graft function or primary nonfunction. The occurrence of these disorders was examined as a function of donor and recipient age and sex, cause of ESRD, HLA compatibility, ABO and Rh compatibility, cold ischemia time, warm ischemia time, antileukocyte antibody level (PRA), and period of dialysis therapy before transplantation. The study showed that a high maximal PRA level, incompatibility for ABO group, and a longer warm ischemia time increase the probability of early graft function disorders.     

Factors that impact on immediate graft function in patients after renal transplantation

Kidney transplantation has become therapy of choice for patients with end-stage renal failure. However, many factors may cause graft rejection or delayed graft function, both of which decrease the prognosis for graft survival. For transplantologists the most important endeavor is to eliminate factors responsible for shortening graft function and to find those predictive of immediate graft function. The aim of the study was to investigate which factors influence early graft function. We retrospectively reviewed 442 renal transplant patients performed between 1990 and 1995 in two Szezecin units. All patients received an identical immunosuppressive drug schedule. Three hundred twelve patients who displayed immediate graft function were included in the study group to analyze donor and recipient age and sex, etiology of ESRD, HLA compatibility AB0 and Rh compatibility cold ischemia time, warm ischemia time, antileukocytes antibodies (PRA), and period of dialysis therapy before transplantation. We observed statistical significance for HLA and AB0 compatibility, younger donor age, and shorter cold ischemia time as the most important factors predictive of early graft function and an improved prognosis for graft survival.     

Allogeneic hand transplantation and rehabilitation of hand function: a 10‐year follow‐up study

The purpose of this study is to present the long‐term outcomes of allogenic hand transplantations performed at our centre. Between January 2001 and October 2002, five allogeneic limb transplantations were performed in three patients (two bilateral forearm and one left hand transplantation). Donors and recipients were matched for blood types (ABO/Rh) and had at least two human leukocyte antigen (HLA) matches. A comprehensive rehabilitation plan integrating preoperative, intraoperative and postoperative management was developed for each patient. After 10 years, all transplantations were performed successfully without complications. As of 2014, all grafts were viable. The transplanted hands showed palmate morphology, perceived superficial pain and tactile sensations, and the static two‐point discrimination ranged from 2·5 to 4·0 mm. Chronic rejection at 4 years after surgery reduced hand function in case 2. Grip strength ranged from 3 kg (case 2) to 16–18 kg (case 1) to 41–43 kg for case 3. Lifting strength ranged from 3 kg (case 2) to 21–23 kg (case 1) to 47–51 kg for case 3. They lead a completely independent life. In summary, hand function following allogeneic limb transplantation allows the ability to perform tasks of daily living.     

Soluble CD30 concentrations in ESRD patients with and without panel reactive HLA antibodies

BACKGROUND: In this retrospective study we compared accuracy of panel reactive antibodies (PRA) with serum soluble CD30 (sCD30) contents in predicting acute rejection crisis post-renal transplant. METHODS: Pre-transplant sera from 115 patients were evaluated for their PRA and sCD30 concentrations. All patients received calcineurin inhibitor-based immunosuppressive therapy. Objective measurements for rejection were biopsy-proven acute rejection (AR) episodes within first six months of the transplant. Post-transplant sera of patients with AR were tested for the presence of donor-specific HLA antibodies (DSA). RESULTS: Overall AR rate was 16% (18/115). Patients positive for PRA and sCD30 tests were at significantly higher risk for AVR compared with those patients negative for both the tests (36% vs. 5%, p=0.01). Among negative PRA patients risk for AR was significantly elevated if they were also tested positive for sCD30 concentrations (21% vs. 5%, p=0.04). Of the 18 patients with AR, 14 were positive for sCD30, and 13 of them (93%) developed DSA post-transplant (p=0.001). CONCLUSION: These data showed that patients positive for sCD30 contents are at high risk for the development of DSA and AR post-transplant regardless of their pre-transplant PRA.     

Detection of anti-HLA antibody by flow cytometry in patients with a left ventricular assist device is associated with early rejection following heart transplantation

BACKGROUND: Patients with a left ventricular assist device (LVAD) as a bridge to heart transplantation (HT) often have elevated levels of panel reactive antibodies (PRA). The clinical significance of anti-human histocompatibility leukocyte antigen (HLA) antibodies detected by flow cytometry in PRA negative patients remains unclear. METHODS: Eighteen patients who underwent LVAD placement as a successful bridge to HT had standard anti-human globulin complement-dependent cytotoxicity and retrospective flow cytometry assays performed to detect class I anti-HLA antibodies. A positive flow result was defined as a fluorescent ratio of 23:1 versus a negative control. RESULTS: Six patients had anti-HLA antibodies detected by flow cytometry. Univariate analysis demonstrated more moderate-severe rejection episodes (ISHLT > or = IIIA) at 2 months (0.83+/-0.75 vs. 0; P=0.04) and a trend toward decreased time to first rejection (61+/-17 vs. 225+/-62 days; P=0.06) in these patients. No differences were observed in donor-recipient HLA mismatch or 1 year Kaplan-Meier survival between patients with or without anti-HLA antibodies. CONCLUSION: Despite a negative PRA, LVAD patients with class I anti-HLA antibodies detected by flow cytometry have a greater incidence of moderate-severe rejection in the first 2 months after HT. Flow cytometry may be a useful clinical tool in screening PRA negative LVAD patients before transplantation. Patients with positive anti-HLA antibody screening by flow cytometry may require more intensive immunosuppression in the early post-HT period.