高度致敏受者行肾移植术的临床研究

目的探讨高度致敏（下称高敏）肾移植受者的组织配型和抗排斥治疗方案。方法对81例高敏肾移植受者的人类白细胞抗原（HLA）抗体、HLA配型和肾移植结果进行回顾性分析。结果81例受者共行肾移植术85次。术后发生超急性排斥反应（HAR）6例（7．1％）；急性排斥反应（AR）17例（21．0％），其中急性体液性排斥反应（AHR）9例（11．1％）。经抗胸腺细胞球蛋白（ATG）、血浆分离（PP）和静脉注射大剂量免疫球蛋白（IVIG）等治疗后均逆转。AR组术前峰值群体反应性抗体（PRA）（58．6±12．4）％，抗原错配（2．9±1．3）个；未发生AR组术前峰值PRA（60．5±14．5）％，抗原错配（1．9±0．8）个。两组PRA值差异无统计学意义（P〉0．05），抗原错配数差异有统计学意义（P〈0．01）。结论避开相应抗体的良好HLA配型（HLA错配数小于或等于2个）是高敏受者肾移植成功的关键。高敏受者术后AHR的发生率高，采用ATG、PP、IVIG联合治疗能有效逆转AHR。

Clinical research on renal transplantation of highly sensitized recipients

Objective To explore the protocol of tissue matching and antiejection therapy in highly sensitized patients（HSP）. Methods To investigate retrospectively the panel reactive antibody （PRA） ,human leukocyte antigen （HLA） matching and renal transplantation results of 81 HSPs. Results 85 cases of kidney transplantation were performed in 81 recipients. Hyperacute rejection occurred in 6 cases （7.1%）. Acute rejection（AR） occurred in 17 patients including 9 cases of acute humoral rejection （AHR）] and reversed by anti-rejection therapy with antithymocyte globulin （ATG）,plasmapheresis （PP） and intravenous immunoglobulin （IVIG）. The HLA antigens mismatch of AR group was significantly higher than non-AR group（2. 9± 1.3 vs. 1.9±0.8,P〈0.01） with no significant difference of pre-transplant PRA levels between two groups（58.6%±12.40/00 vs. 60.5%±14.5% ,P〉0. 05）. Conclusion To avoid specific antibody through good HLA matching（HLA antigens mismatch≤2） is the key point for successful renal transplantation of HSP. The incidence of AHR in HSP is very high. Therapy with ATG＋PP＋ IVIG is effective for the treatment of AHR.