群体反应性抗体对肾移植后人/肾存活率影响的临床分析

目的回顾性调查群体反应性抗体(PRA)对肾移植术后1、3、5年人/肾存活率的影响。方法纳入北京军区第二八一医院2000年1月~2012年3月肾移植受者469例,采用酶联免疫吸附法(ELISA)检测受者移植前PRA水平,以PRA≤10%为阴性结果,10%40%为高度致敏,并对1、3、5年人/肾存活率进行统计。结果 469例肾移植受者中,PRA阴性349例(阴性组),PRA阳性120例(阳性组),其中Ⅰ类抗体阳性66例,Ⅱ类抗体阳性31例,23例同时存在Ⅰ类和Ⅱ类抗体。术前PRA阴性组与阳性组1、3、5年人存活率分别为98.3%、90.9%、80.7%和93.3%、82.9%、62.9%;1、3、5年肾存活率分别为96.8%、87.9%、75.9%和86.7%、76.1%、50.5%,二组相比1、3、5年人/肾存活率均差异有统计学意义(P<0.05),轻度致敏组的1、3、5年人存活率、肾存活率与PRA阴性组相比,差异无统计学意义(P>0.05);中度致敏组的1、3、5年人/肾存活率与阴性组比较,差异有统计学意义(P<0.05);高度致敏组的1、3、5年人/肾存活率与阴性组比较,差异有统计学意义(P<0.05)。结论 PRA是肾脏移植术前筛选致敏受者的重要指标,PRA阳性会影响移植物的长期存活,PRA阳性患者在肾移植手术前必须进行严格的组织配型,采取措施降低抗体水平,选择合适的供体与手术时机,以提高人/肾存活率。

Analysis of patient/graft survival rate of renal transplant recipients for panel reactive antibodies

Objective To retrospectively analyze the patient/graft survival rate of renal transplant recipients for panel reactive antibodies （PRA） in 1,3,5 years.Methods The patients received renal transplantations at the 281st Hospital of Beijing Military Area Command from January 2000 to March 2012 were included.Renal transplant recipients were preoperatively tested by enzyme linked immunosorbent assay （ELISA） with Lambda antigen tray （LAT）.According to the PRA level,the recipients were divided into negative group （PRA≤ 10％） and positive group （PRA＞10％）,and 3 subgroups with 10％＜PRA≤20％ （lowly sensitive group） and 20％＜PRA≤40％ （moderate sensitive group） and PRA＞40％（highly sensitive group）.Statistical survival rate of patient/graft in 1,3,5 years were analyzed.Results In the renal allograft recipent of the 469 case,the PRA nogative were 349 cases.The positive were 120 cases （34.4％）.Type Ⅰ antibody positive were 66 case,type Ⅱ antibody were 31 case,Ⅰ and Ⅱ were 23 cases in the sometime.In PRA negative and positive before renal allograft surgery,patien survival rates in 1,3,5 years were 98.3％,90.9％,80.7％ and 93.3％,82.9％,62.9％; renal survival rates were 96.8％,87.9％,75.9％ and 86.7％,76.1％,50.5％ separately,the differences were statistically significant （P ＜ 0.05）.But the differences of patient/kidney survival rates in 1,3,5 years between lowly sensitive group and negative group were not statistically significant （P ＞ 0.05）.The differences of patient/graft survival rates in 5 years between moderate sensitive group and negative group were statistically significant （P ＜ 0.05）.The differences of patient/graft survival rates in 1,3,5 year between highly sensitive group and negative group were statistically significant （P ＜ 0.05）.Conclusion The test PRA is an important target of screening susceptible recipient before renal allograft.Patients with PRA positive result may influence the long term survival after renal transplantation.Well-mnatched HLA typing and lower levels of antibodies,choosing the appropriate donor and timing of surgury,all of these may increase the patient/graft survival rate in sensitized recipients.