肾移植致敏受者的配型研究及应用

目的:探讨人类白细胞抗原(HLA)配型在肾移植致敏受者中的应用及意义。方法:对32例PRA阳性的肾移植受者采用HLA交叉反应组(CREGs)配型原则选择供者,观察其供受者相配情况及移植效果。结果:按交叉反应组配型原则,供受者HLACREGS+DR0,1,2和3错配(MM)分别为8例(25％)、10例(31.25％)、12例(37.5％)和2例(6.25％),无4～6错配;而按传统的HLA-A,B,DR抗原配型原则,其0,1,2,3和4MM分别为2例(6.25％)、3例(9.38％)、10例(31.25％)、9例(28.12％)和8例(25％),其中0～1错配仅有5例。肾移植术后仅有9例发生急性排斥反应,经OKT_3治疗逆转,所有受者术后肾功能均恢复正常。结论:良好的HLA CREGs配型,可以显著提高供受者相配率,对减少致敏受者的排斥反应,提高移植肾存活率具有重要的意义。

Investigaton of HLA Matching in Sensitized Recipients of Renal Allografts

Objective To investigate the application and significance of human leukocyte antigen (HLA) matching in sensitized recipients of renal allografts.MethodS The donors were selected by HLA CREGs matching for 32 sensitized recipients of renal allografts whose PRA were positive (PRA>10%). The post-transplantation outcome was observed. Results The rate of positive PRA in the 32 recipients was from 17% to 89% and averagely 39.84%. Patients with 0,1,2 or 3 MM of HLA CREGs+DR were 8(25%),10(31.25%),12(37.5%)and 2(6.25%) case respectively according to the rule of CRESs matching and no case had 4-6MM in the 32 recipients. However the cases of 0,1,2,3 and 4 MM were 2(6.25%),3(9.38%),10(31.25%),9(28.12%) and 8(25%) respectively and only 5 cases shared 0-1MM when the standard of conventional HLA antigen matching was used.Only 9 patients developed a-cute rejection and were reversed by OKT3 treatment.Renal function returned to normality in all the patients.ConclllSions Using CREGs matching criteria would significantly increase the chance to receive well-matched kidney in recipients and provide more chance for waiting recipients. Good HLA matching plays an important role in reducing the incidence of acute rejection and improving graft survival in the sensitized patients.