肾移植前后群体反应性抗体变化与急性排斥反应

目的:群体反应性抗体可诱导肾移植后急性排斥反应的发生,但群体反应性Ⅰ、Ⅱ类抗体哪一种同排斥反应关系更密切,目前国内报道较少.观察肾移植前后群体反应性Ⅰ、Ⅱ类抗体变化,分析不同抗体变化与排斥反应的关系.方法:选择2008-01/12于北京朝阳医院泌尿外科施行肾移植100例患者中移植前后群体反应性Ⅰ、Ⅱ类抗体水平发生变化18例.通过秩和检验统计移植前后群体反应性Ⅰ、Ⅱ类抗体水平变化,分析抗体变化同移植后急性排斥反应之间的关系.结果:18例患者均进入结果分析.18例中9例发生急性排斥反应,移植后群体反应性Ⅱ类抗体水平较移植前显著升高(P=0.04),群体反应性Ⅰ类抗体水平无明显变化(P=0.707);9例未发生急性排斥反应患者其移植前后群体反应性Ⅰ、Ⅱ类抗体水平变化均无显著性意义.移植后群体反应性抗体总体水平升高者7例,其中以群体反应性Ⅱ类抗体升高为主5例,发生急性排斥反应4例,该4例患者中1例因急性排斥反应导致移植肾丢失;以群体反应性Ⅰ类抗体升高为主2例均未发生急性排斥反应.移植后群体反应性抗体总体降低11例,以群体反应性Ⅱ类抗体降低为主5例,发生急性排斥反应1例:以群体反应性Ⅰ类抗体降低为主6例,发生急性排斥反应4例.结论:群体反应性Ⅱ类抗体升高易导致急性排斥反应,移植后群体反应性Ⅱ类抗体升高与急性排斥反应有明确的相关性,与群体反应性Ⅰ类抗体水平变化无关.

Changes of panel reactive antibody after kidney transplantation and acute rejection

OBJECTIVE: Panel reactive antibody (PRA) can induce acute rejection following kidney transplantation, however, it is poorly understood which PRA is more associated with rejection. Therefore, the aim of this study is to analyze the correlation between PRA and rejection by observing the change of PRA Ⅰ and PRA Ⅱ prior to and after the kidney transplantation. METHODS: Levels of PRA Ⅰ and PRA Ⅱ were observed in 100 patients received kidney transplantation at the Department of Urology, Beijing Chaoyang Hospital Affiliated to the Capital Medical University. During these 100 patients, 18 patients had PRA changes after operation. The relationship between PRA changes after kidney transplantation and acute rejection were analyzed. RESULTS: Totally 18 patients were included in the final analysis. Nine of them occurred acute rejection with obviously increased PRA Ⅱ (P=0.040), however, the PRA Ⅰ had no significant changes (P=0.707). The changes of PRA Ⅰ and PRA Ⅱ had no significance in the remaining 9 patients prior to and after kidney transplantation. The overall level of PRA increased in 7 patients, in 5 patients with increased PRA Ⅱ, 4 patients suffered acute rejection, 1 of which was renal allogreft failure; 2 cases with PRA Ⅰ increasing did not occur acute rejection. The overall level of PRA declined in 11 patients, including 5 patients with PRA Ⅱ decreased, 1 patient occurred acute rejection; 4 patients in 6 patients with PRA Ⅰ declined suffered acute rejection. CONCLUSIONS: The increased PRA Ⅱ after transplantation easily result in acute rejection, which has definite correlation to acute rejection, however, the PRA Ⅰ changes has no impact on acute rejection.