动态监测供者特异性抗体与非供者特异性抗体判断移植肾预后的临床意义

目的 动态监测肾移植前后供者HLA特异性抗体(DSA)及非供者HLA特异性抗体(NDSA)的变化,观察其对移植肾预后的影响.方法 采用免疫荧光液相芯片(Luminex)技术检测8例肾移植患者术前HLA基因分型、术前和术后的特异性HLA抗体改变.结果 术前HLA抗体阴性者4例,术后1例并发肺部感染死亡,另3例半年内HLA抗体阴性,肾功能良好.2例移植前后检测HLA抗体阳性,术后半年抗体滴度明显逐渐增高,分离出DR11(DSA);DR12、DQ7、DQ8(NDSA).1例术前存在A11(DSA),A34(NDSA)抗体,术后1个月始NDSA增多,且其分值呈上升趋势.1例术前存在DR.15(DSA)抗体,术后1周发生急性排斥反应行移植肾切除.结论 肾移植前受者存在DSA会导致移植肾急性排斥,特别是存在HLA-Ⅱ类抗体.在随访期间HLA抗体滴度和类型持续升高者,应鉴定其DSA与NDSA类型,尽早采用有效的治疗方法 减少移植肾功能减退及排斥反应的发生和发展.     

肾移植术后特异性HLA抗体对急性排斥的影响

目的评价肾移植术后特异性HLA抗体对移植肾急性排斥的影响.方法采用前瞻性队列研究,通过酶联免疫吸附(ELISA)法检测136例肾移植患者围手术期特异性HLA抗体水平,随访观察HLA抗体对急性排斥的影响.结果术后HLA抗体阳性组急性排斥发生率高于阴性组(32.65%vs13.79%,P=0.000).按照HLA-Ⅰ类和Ⅱ类抗体水平分组后,移植肾无排斥存活率依次为HLA-Ⅰ-/Ⅱ-组＞HLA-Ⅰ-/Ⅱ+组＞HLA-Ⅰ+/Ⅱ-组＞HLA-Ⅰ+/Ⅱ+组(P=0.03).结论术后特异性HLA抗体可能是引起移植肾急性排斥的原因之一,HLA-Ⅰ类抗体与急性排斥关系较为密切.     

肾移植术后供者特异性抗体对移植肾近期效果的影响

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2001年1月至2002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(56．3％)高于抗体阴性组(11．9％)，P=0．000；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=0．102；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。     

采用流式细胞微珠法检测肾移植受者体内供者特异性抗体39例

目的 应用流式细胞微珠法检测肾移植受者供者特异性抗体(DSA),并探讨DSA阳性受者的HLA配型及移植物排斥反应发生情况.方法 检测39例亲属肾移植受者移植前、后的DSA,检测供、受者HLA错配情况,记录受者移植后排斥反应的发生情况.分析DSA阳性及阴性受者的HLA错配及排斥反应的发生情况.结果 39例共检测DSA 313次,其中移植前78次,移植后235次,移植前出现DSA阳性的均暂缓手术.5例HLA无错配的受者移植后DSA均为阴性,34例HLA错配的受者移植后12例出现DSA阳性(35.3％,P＜0.05).12例DSA阳性受者中,5例发生排斥反应(41.7％),其排斥反应发生率显著高于DSA阴性的移植受者(7.4％,P＜0.05).发生排斥反应且DSA阳性受者的单抗原微珠免疫荧光强度均值为5723.9±1030.5,高于未发生排斥反应的DSA阳性者的2355.2±609.7(P＜0.05).DSA阳性的受者治疗后,DSA免疫荧光强度有所下降.结论 采用流式细胞微珠法动态监测DSA效果较好,有利于预测和及时防治肾移植后排斥反应.     

Luminex技术与ELISA方法检测抗HLA抗体在肾移植急性排斥反应中的应用

目的 探讨用Luminex技术与酶联免疫吸附试验(ELISA)方法检测肾移植受者抗HLA抗体的结果差异及其与移植后早期急性排斥反应(AR)的关系.方法 以2010年10月至2012年10月接受亲属活体肾移植的34例受者为研究对象,术前采集受者血清,同时应用Luminex技术与ELISA方法进行抗HLA-Ⅰ类、Ⅱ类抗体检测,并且记录术后早期AR发生情况.结果 用Luminex技术检测抗HLA-Ⅰ类抗体阳性率为41.2％(14/34),检测抗HLA-Ⅱ类抗体阳性率为38.2％(13/34);用ELISA方法检测抗HLA-Ⅰ类抗体阳性率为2.9％(1/34),检测抗HLA-Ⅱ类抗体阳性率为8.8％(3/34);两种方法检测抗HLA-Ⅰ类、Ⅱ类抗体阳性率的差异有统计学意义(x2=14.46,P＜0.05;x2 =8.17,P＜0.05).用Luminex技术检测18例术前抗体阳性者中有8例术后早期发生AR(占44.4％);16例术前抗体阴性者中,有2例术后早期发生AR(占12.5％).用ELISA方法检测4例术前抗体阳性者中,有3例术后早期发生AR(占75.0％);30例术前抗体阴性者中,有7例术后早期发生AR(占23.3％).结论 Luminex技术检测肾移植受者抗HLA抗体的检出阳性率高于ELISA方法,对于移植后早期AR的监测可以提供有用的信息.     

肾移植受者术前测定抗HLA-IgG抗体的临床意义

目的　研究肾移植受者术前抗HLA IgG抗体水平的临床意义。 方法　采用酶联免疫吸附法 (ELISA)检测 184例肾移植受者术前抗HLA IgG抗体水平。分析抗HLA IgGI类抗体、Ⅱ类抗体阳性与急性排斥反应发生的关系。结果　肾移植受者术前抗HLA IgG抗体阴性者 15 5例 ,其中18例发生排斥反应 ,发生率 11.6 % ;抗HLA IgGⅠ类抗体阳性者 7例 ,2例发生排斥反应 ,发生率2 8.5 7% ;抗HLA IgGⅡ类抗体阳性者 9例 ,4例发生排斥反应 ,发生率4 4 .4 4 % ;Ⅰ类抗体、Ⅱ类抗体均阳性者 13例 ,8例发生排斥反应 ,发生率 6 1.5 3% ,与阴性对照组比较 ,差异有显著性 (P <0 .0 0 1)。结论　肾移植受者术前抗HLA IgG抗体阳性与术后排斥反应发生率密切相关 ,提示术前检测抗HLA IgG抗体具有重要的临床意义 ,可以预测排斥反应及指导治疗。     

肾移植患者应用ELISA方法检测HLA抗体的价值

目的 探讨ELISA方法检测HLA抗体在临床肾移植中的应用价值。方法 在167例次肾移植受者中应用ELISA方法检测HILA抗体,比较不同抗体水平患者的移植效果及抗体水平在发生排斥反应前后的变化。结果 不同抗体水平组的移植效果有显著性差异(P<0.05)。术后抗体水平变化与急性排斥反应的发生及逆转呈现正则关。结论 ELISA方法检测HLA抗体对于预测移植风险、辅助诊断排斥反应都有较高的临床应用价值。     

群体反应性抗体在肾移植中的意义

目的 研究群体反应性抗体（ＰＲＡ０在肾移植中的意义。方法 对１７８例肾移植患者进行了术前、术后ＰＲＡ检测。结果 肾移植术前ＰＲＡ阳性患者有２３例,肾移植术后发生急性排斥反应的为２０例。术后ＰＲＡ阳性受者５８例,发生排斥反应的有３４例。移植前后ＰＲＡ阴性患者有１０８例,有８例发生排斥。在肾移植患者中所产生的抗ＨＬＡ抗体的频率和ＨＬＡ抗原的分布不同。结论 ＰＲＡ检测对预测移植肾排斥有重要意义。     

抗HLA和抗MICA抗体的表达对移植肾功能和急性排斥反应的预示作用

目的 探讨抗HLA与抗主要组织相容性复合物Ⅰ类链相关基因A(MICA)抗体的表达对移植肾功能和急性排斥反应的预示作用.方法 采用免疫磁珠流式液相芯片技术检测41例肾移植受者移植前后的抗HLA和抗MICA抗体,其中37例接受了1、3、6个月及1、2、3年的动态随访.分析抗HLA和抗MICA抗体的特异性,及其与血清肌酐和排斥反应的相关性.结果 移植前共有9例(22.0%,9/41)预存抗HLA或(和)抗MICA抗体,其巾抗HLA抗体阳性2例(4.9%,2/41),抗MICA抗体阳性6例(14.6%,6/41),抗HLA和抗MICA抗体均阳性1例(2.4%,1/41).另外有5例抗MICA抗体可疑阳性.除1例的抗MICA抗体为供者特异性抗体(DSA)外,其余均为非供者特异性抗体(NDSA).37例随访者中,6例新生抗HLA抗体(16.2%),3例新生抗MICA抗体(8.1%),新生抗HLA抗体者的抗体滴度在随访3年中呈现上升趋势.9例预存抗体的受者,有4例(44.4%,4/9)发生排斥反应;6例新生抗HLA抗体的受者中,有3例(50.0%)发生急性排斥反应,而3例新生抗MICA抗体的受者均无排斥反应发生,二者间的差异有统计学意义(P＜0.05).新生抗HLA抗体产生较早(术后3 d和7 d)的2例受者均检测到抗HLAⅡ类DSA,其移植肾均因排斥反应而切除.预存抗MICA抗体,且移植后发生排斥反应者在随访的每个时间点上的血清肌酐水平均高于预存抗MICA抗体但无排斥反应者(P＜0.05);移植前抗HLA和抗MICA抗体均阴性者,术后发生排斥反应者在随访的每个时间点上的血清肌酐水平均高于抗体阴性且无排斥反应者(P＜0.01);无论是新生抗HLA抗体还是抗MICA抗体,移植后1个月发生排斥反应者的血肌酐均明显高于抗体阴性且无排斥反应者(P＜0.01).结论 预存和新生抗HLA抗体是移植后发生急性排斥反应的重要因素,而供、受者HLA和MICA基因错配是产生新生抗体的重要原因.     

动态分析HLA和MICA特异性抗体对移植肾功能的影响

目的 探讨肾移植前后人类白细胞抗原(HLA)和主要组织相容性一类相关链A基因(MICA)抗体特异性对移植后排斥反应和移植肾功能的影响. 方法采用免疫荧光液相芯片技术检测27例肾移植(尸供22例,亲属活体供肾5例)受者手术前后抗HLA抗体和MICA抗体的特异性和阳性值变化,并结合供受者的基因分型,区分供体特异性抗体和非供体特异性抗体.取同期的临床资料和SCr水平进行分析. 结果 27例移植患者中带肾存活26例,移植肾失功1例.移植后1、3、6、12个月时动态随访24例,失访2例.27例患者移植前预存抗体7例(25.9%),其中HLA抗体阳性2例、MICA抗体阳性3例,HLA和MICA抗体均阳性2例.肾移植前HLA和MICA抗体均阴性者中移植后3～6个月产生新生抗体3例.1例新生HLA-Ⅱ类特异性抗体者,移植半年后出现慢性排斥反应,经治疗术后1年SCr>200 btmol/L.3例肾移植前MICA抗体阳性者,术后MICA抗体的特异性均无改变,但抗体的阳性分值呈现2～8分的变化,1年后均升高到移植前(4～8分)水平.移植前预存低阳性率HLA-Ⅱ类特异性抗体者1例,移植后2周有发热等排斥反应,巨细胞病毒检测阳性,移植后1个月时SCr为171μmol/L,3个月升高到236μmol/L.24例分为抗体阴性组(14例)和抗体阳性组(10例).移植后1个月和1年时SCr水平2组间比较差异有统计学意义(P=0.03,0.05). 结论 移植后3～6个月是新生抗体变化的重要随访时间,可根据HLA和MICA抗体的特异性和阳性分值变化,尽早采取有效方法预防排斥反应和减少移植肾功能减退的发生和发展.     

Everolimus-based Immunosuppression Possibly Suppresses Mean Fluorescence Intensity Values of De Novo Donor-specific Antibodies After Primary Kidney Transplantation

PurposeWe evaluated de novo donor-specific antibody (DSA) production of everolimus (EVR)-based immunosuppression for primary kidney transplant recipients involved in the A1202 study at our institute.MethodsFrom March 2008 to August 2009, 24 recipients were prospectively randomized into 2 groups. The EVR group received reduced cyclosporin A and EVR. The standard protocol (STD) group received standard cyclosporin A and mycophenolate mofetil. Both groups received basiliximab and steroids. De novo DSA was identified using LABScreen single antigen beads (One Lambda, Canoga Park, Calif., United States). Mean fluorescence intensity (MFI) values > 1000 were considered positive. P < .05 was considered significant.ResultsGraft survival was 100% in the EVR group and 90.9% in the STD group. All patients remained on the primary protocol in the EVR group, but 3 patients in the STD group (27.3%) were converted to tacrolimus due to DSA and non-adherence. Estimated glomerular filtration rate was similar in both groups. No EVR group recipients and 9.1% of STD group recipients were treated for T-cell-mediated rejection. No recipients of the EVR group exhibited peritubular capillaritis, while 9.1% in STD group developed chronic active antibody-mediated rejection. LABScreen revealed an accumulative class II DSA production rate of 15.4% in the EVR group and 18.3% in the STD group at 10 years. When the MFI cut-off level was set to 6000, anti-HLA antibody and de novo DSA-free survival was significantly better in the EVR group.ConclusionsEVR-based immunosuppression provided equivalent or even better clinical outcomes. EVR suppressed de novo DSA production at 10 years follow-up; however, further follow-up is inevitable.     

Antibodies to cryptic epitopes on HLA class I and class II heavy chains bound to single antigen beads: Clinically relevant?

Cell surface HLA class I consists of trimers, i.e., alpha - heavy chain, beta – 2 - microglobulin, and a peptide, termed closed conformers (CC) on non-activated lymphocytes. HLA class I and class II may also exist, respectively, as alpha-chain only or alpha and beta - chain only on activated cells termed open conformers (OC). We extend previous studies using an OC-specific monoclonal antibody that demonstrate LABScreen HLA class I and II single antigen beads (SABs) contain a mixture of open and closed conformers. LIFECODES SABs have bound CC only. More HLA class I and class II LABScreen SABs were reactive than LIFECODES SABs due to the presence of OC on LABScreen SABs. We hypothesized that antibody against OC on HLA B antigens would not be detected in cell based cross matches (XMs) with typical lymphocyte targets since anti-HLA OC antibodies would not react with native HLA CC on the cell surface. To test this hypothesis, we performed flow cytometry XM (FCXM) assays with sera of sufficient strength that most laboratories would likely predict positive FCXMs. Sera that reacted strongly with LABScreen SABs (>13,000 MFI) but weakly or not at all with LIFECODES SABs (<1000 MFI) gave negative T and B cell FCXMs. In contrast, sera that reacted with LIFECODES SABs (>13,000 MFI) but weakly with LABScreen SABs (<2100 MFI) exhibited positive FCXMs. Detection of antibodies directed against OC in SAB assays, may lead to inappropriate listing of unacceptable antigens, a decision not to XM or pre-or post – transplant desensitization procedures.     

Multi-array antibody screening in detecting antibodies to mismatched HLA in patients awaiting a second transplant

Effective identification of HLA specificities to which a prospective transplant recipient has antibodies depends on how effective the most sensitive assay is in detecting these antibodies. To ascertain the assay's efficacy, the results of antibody screening of patients on the waiting list for a second transplant were studied. A commercially available panel of fluoro-coded microbeads coated with multiple and single purified class I or II HLA antigens was used with flow cytometry to detect antibodies in human serum (LABScreen, One Lambda, Canoga Park, Calif, USA). A total of 112 HLA-A, B, and DR mismatches between donors and recipients were present among 34 patients. Antibodies to 56% of the mismatches were detected with 67% of the HLA-A, 38% of the HLA-B, and 63% of the HLA-DR mismatches detected, respectively. Thirty percent of the patients had antibodies to all of the mismatched HLA, 43% had antibodies to some, and 27% did not develop antibodies to any of the mismatched antigens. Among patients who developed antibodies to all of the mismatched HLA, 60% had had a transplant nephrectomy. Only 11% of patients who had no antibodies detected to mismatched HLA had had a transplant nephrectomy and 44% of them were still on immunosuppression. Using the Matchmaker program developed by Duquesnoy, the latter group of patients had a sufficient number of triplet mismatches that could have resulted in an antibody response. All of the undetected antibodies had been identified in other patients in this group. The assay used in this study to detect antibodies is considered the most sensitive one available. Nonetheless, antibodies to slightly less than half of the mismatched HLA antigens were not detected. It appears that the assay system is capable of detecting the antibodies, since in other patients with the same mismatched HLA, antibodies were detected. It is likely that the recipients could develop antibodies since there was a sufficient degree of disparity in the HLA of donors and recipients. Antibodies were more likely to be detected when there had been a transplant nephrectomy and the absence of immunosuppression. There was no way of knowing whether we were missing detecting antibodies or if they were not present. The results of this study have important implications with respect to utilizing "unacceptable antigens" in an allocation system for patients awaiting a second transplant.     

定期检测肾移植患者尿中供者细胞DNA的临床意义

目的 探讨肾移植患者尿中供者细胞的出现与急性排斥反应的相关关系及其临床意义。方法 以供者为男性、受者为女性或HLA—DB抗原有错配的80例肾移植患者为研究对象，定期收集尿液标本，从中提取DNA，利用聚合酶链反应及序列特异性引物—聚合酶链反应分别检测Y染色体上特异的基因片段DYZ—l和HLA-DR抗原的基因DRB1。结果 手术当天受者的尿中即有供者细胞出现，随着时间的推移，尿中供者细胞DNA的基因表达强度逐渐减弱，直至术后30d，仍有90．0％患者的尿中有供者细胞DNA的基因表达，其中8例(29．6％)发生了急性排斥反应；出院后发生急性排斥反应者，90．0％的尿液标本中能检测到供者细胞DNA，抗排斥治疗结束后2周，83．3％仍为阳性，治疗过程中尿中供者细胞DNA的基因表达强度逐渐减弱，直至3个月后，88．9％转为阴性；肾功能良好的稳定期患者，仅6．7％的患者尿中DYZ—l或HLA-DRB1基因阳性。结论 肾移植患者尿中供者细胞DNA的检测可以作为诊断急性排斥反应，并与药物性肾功能损伤进行鉴别的一种方法，其基因表达强度变化为定量评价排斥反应提供了可能性。     

Clinical relevance of pre and post-transplant immune markers in kidney allograft recipients: anti-HLA and MICA antibodies and serum levels of sCD30 and sMICA

BackgroundThis retrospective study aims to determine the prognostic values of HLA and MICA antibodies, serum levels of sCD30 and soluble form of MHC class I related chain A (sMICA) in kidney allograft recipients.MethodsSera samples of 40 living unrelated donor kidney recipients were tested by ELISA and Flow beads techniques for the presence of anti HLA and MICA antibodies and the contents of sCD30 and sMICA. HLA and MICA antibody specification was performed by LABScreen single antigen beads to determine whether the antibodies were directed against donor mismatches.ResultsWithin first year post operatively 9 of 40 patients (22.5%) showed acute rejection episodes (ARE) that four of them lost their grafts compared to 31 functioning transplants (P = 0.001). The presence of HLA antibodies before and after transplantation was significantly associated with ARE (P = 0.01 and P = 0.02 respectively). Sensitization to HLA class II antigens pre-transplant was strongly associated with higher incidence of ARE (P = 0.004). A significant correlation was found between ARE and appearance of non-donor specific antibodies (P = 0.02). HLA antibody positive patients either before or after transplantation showed lower graft survival rates than those without antibodies during three years follow-up (P = 0.04 and P = 0.02). Anti-MICA antibodies were observed in 8/40(20%) and 5/40(12.5%) of patients pre and post-transplant respectively. Coexistence of HLA and MICA antibodies was shown in 2 of 4 cases with graft loss. A significant increased level of sCD30 at day 14 (P = 0.001) and insignificant decreased levels of sMICA pre and post operatively were detected in rejecting transplants compared to functioning graft group.ConclusionOur findings support the view that monitoring of HLA and MICA antibodies as well as sCD30 levels early after transplant has predictive value for early and late allograft dysfunctions and the presence of these factors are detrimental to graft function and survival.     

肾移植受者群体反应性抗体监测的临床意义

目的 分析群体反应性抗体（PRA）监测对预测肾移植受者排斥反应发生的意义及探讨对高水平PRA受者的临床处理.方法 应用酶联免疫吸附分析法（ELISA法）动态监测肾移植受者的PRA水平,以PRA≥10%为阳性,10%≤PRA＜50%为低致敏、PRA≥50%为高致敏,并对37例术前高致敏患者行血浆置换.结果 1527例肾移植受者中,PRA阳性350例（22.9% ）,其中高致敏 94例（26.8% ）;PRA阳性组排斥反应发生率（21.1% ）高于PRA阴性组（3.8% , P〈0.01）, 术后PRA转为阳性组排斥反应发生率高于PRA无变化组（P〈0.01）,行血浆置换受者与未行血浆置换受者排斥反应发生率无差异（P〉0.05）,接受过移植、多次妊娠、多次输血受者易致敏,HLA-A、B、DR配型错配抗原〉3个受者急性排斥的发生率（16.9% ）明显高于错配抗原≤3个受者（1.7% , P〈0.01）.结论 动态监测PRA水平有助于预测排斥反应的发生.     

Identification of the antibodies involved in B-cell crossmatch positivity in renal transplantation

BACKGROUND: The significance of a positive B-cell crossmatch (BCM) in kidney transplantation has always been controversial in the evaluation of its implications on graft survival and specificity of the antibodies involved. METHODS: We have investigated the sera of 62 recipients of a kidney allograft transplanted across a positive BCM (T negative) for the presence of autoantibodies and anti-human leukocyte antigen (HLA) class I and II antibodies, using a combination of lymphocytotoxicity, enzyme-linked immunosorbent assay (ELISA), and flow cytometry tests. The controls were the 930 patients transplanted over the same period of time with a negative T and BCM. RESULTS: Autoantibodies were detected in 16%, and donor specific anti-HLA class II antibodies, mainly DQ, in 23% of the patients. None had antibodies against donor HLA class I. The target of the antibodies was not identified in 61%. Graft survival was comparable in the controls and in the +BCM patients, with nondonor-specific HLA reactivity. Patients with donor-specific anti-HLA class II antibodies had lower early graft survival and a higher incidence of vascular rejection. However, long-term allograft survival was similar to that of the other groups. CONCLUSION: These data suggest that in 77% of the patients, BCM positivity was not related with anti-HLA antibodies, and, in this case, graft survival was similar to that of the -BCM controls. In a minority of patients, anti-HLA class II antibodies were responsible for the +BCM, and their presence was associated with lower early, but not long-term, graft survival. Consequently, a +BCM should not systematically contraindicate kidney transplantation.     

抗人类白细胞抗原与抗组织相容性Ⅰ类相关链A位点特异性抗体对移植肾功能的监测价值

目的 探讨抗人类白细胞抗原(HLA)与抗主要组织相容性Ⅰ类相关链A位点(MI-CA)抗体在移植肾功能中的意义.方法 采用免疫磁珠流式液相芯片技术检测135例等待肾移植患者中的抗HLA和抗MICA抗体,其中33例.肾移植患者接受了2年的动态随访;采用PCR-SSOP方法 进行HLA和MICA基因分型并鉴定供者特异性抗体(DSA)和非供者特异性抗体(NDSA),结合血清肌酐水平和临床资料进行分析.结果 34.1%等待肾移植患者(46/135)预存抗HLA和抗MICA抗体.动态随访33例肾移植患者:20例患者移植前后抗体均阴性;10例患者移植前后抗体阳性且类型未改变;3例患者移植6个月后产生新生抗体(9.1%).2例移植前抗体阴性,移植后6个月新生A33、A31和DQ7、DR17、DR18为NDSA抗体,移植后1、2年新生DR12和DR11为DSA抗体;1例移植后1年新增MICA27和MICA02特异性抗体的同时新生HLA-B41、A32抗体.在33例肾移植患者中,抗体阳性组患者与抗体阴性组比较差异有统计学意义(P＜0.05);MICA抗体阳性组患者的血清肌酐水平升高更明显(P＜0.01).结论 无论肾移植前患者是否预存抗HLA和抗MICA抗体,移植后动态监测抗HLA和抗MICA特异性抗体的变化,对预警排斥反应的发生和指导临床治疗来防止移植肾功能减退均具有一定价值.