KIR基因错配对肾移植临床疗效的影响

目的探讨KIR基因错配对肾移植效果的影响。方法调查111对肾移植供受者的KIR基因和受者术后持续随访>37个月
中急性排斥（AR）以及1、3年人/肾存活率的情况。结果（1）肾移植供、受者中均表达17个KIR基因，其中受者KIR3DS1的频率
显著高于供者组（38.75% vs 24.66%，OR=2.17，χ2=3.94，P<0.05）；（2）供受者KIR基因的平均相合率为82.53%；（3）肾移植后AR
组供、受者中KIR2DS1相合率显著高于非AR组（85.00% vs 54.95%，χ2=6.19，P<0.05)，供受者KIR基因型为AB型→AB型的比
率显著高于非AR组（33.33% vs 8.00%，P<0.05）。（4）111例受者的1年人/肾存活率为94.59%，3年存活率为82.88%；预后不良组
中供者呈KIR-AB基因型的比例显著高于预后良好组（57.89% vs 29.63%，χ2=8.19，P<0.05），供、受者均为KIR-AB型的比例亦显
著高于预后良好组（36.84% vs 9.78%，χ2=14.87，P<0.05）。结论KIR3DS1可能与尿毒症具有易感关联。供者或受者任何一方
为KIR-AB型可能与增加移植后AR发生率和降低人/肾的1年和3年生存率相关。避免选择KIR-AB型供体将有益于改善肾移
植的近远期效果，这一发现将对活体肾脏捐献的选择具有重要的医学伦理意义。

Impact of recipient/donor killer cell immunoglobulin- like receptor gene mismatch on outcomes of renal transplant

Objective To explore the impact of killer cell immunoglobulin-like receptor (KIR) gene mismatch on the outcomes of
renal transplantation. Methods We collected the data from 111 donor-recipient pairs of kidney transplant and analyzed the
status of KIR gene matching, acute rejection (AR), and 1-year and 3-year survival of the recipients who were followed
continuously for over 37 months. Results Seventeen KIR genes were expressed in both recipient and donor groups, and the
frequency of KIR3DS1 was significantly higher in the recipients than in the donors (38.75% vs 24.66%, OR=2.17, χ2=3.94, P<
0.05). The average rate of donor-recipient KIR matching was 82.53% . The donor-recipient KIR2DS1 matching rate was
significantly higher in AR group than in no-AR group (85.00% vs 54.95%, χ2=6.19, P<0.05). The rate of donor-recipient KIR
AB-AB genotype was significantly higher in AR group than in no-AR group (33.33% vs 8.00%, P<0.05). The 1- and 3-year
survival rates was 94.59% and 82.88% in these recipients, respectively. The frequency of donor KIR-AB genotpye was
significantly higher in recipients with poor outcomes (57.89% vs 29.63%, χ2=8.19, P<0.05); the frequency of both donor and
recipient KIR-AB genotype was also significantly higher in recipients with poor prognoses (36.84% vs 9.78%, χ2=14.87, P<0.05).
Conclusions KIR3DS1 may be the susceptible gene associated with uremia. A KIR-AB genotype of either the donor or the
recipient can increase the risk of AR and reduce the 1- and 3-year survival rate. This finding can be of ethically importance in
choosing a living related donor.