PRA配型技术在肾移植中的应用研究

目的探讨群体反应性抗体 (PRA)配型新技术对肾移植近远期的效果。方法 85 4例患者肾移植前运用PRA新技术进行组织配型 ,并行血浆置换 ,未采用PRA组织配型的 42 3例作为对照 ,观察肾移植术后免疫指标变化、近期 (AR)发生率以及对长期存活的影响。结果未采用PRA组织配型组发生超急性排斥反应 (HR) 9例 (2 1% )、急性排斥反应 198例 (47% ) ;1年人/肾存活率 86 7% /76 3%、3年人 /肾存活率 72 5 % /6 7 9%、5年人 /肾存活率 6 9 5 % /4 9 3%。采用PRA配型新技术共 85 4例 ,肾移植术后未发生超急性排斥反应 ,发生急性排斥反应 16 2例 (19 0 % ) ,1年人肾存活率达 97 3% /95 0 %、3年人肾存活率 92 0 % /84 2 %、5年人 /肾存活率 87 0 % /81 6 %。结论PRA阴性配型可杜绝超急性排斥反应发生 ,降低急性排斥反应发生率 ,提高人 /肾长期存活率。

Evaluation of the effect of examining histocompatibility of panel reactive antibody before renal transplantation

Objective To evaluate the short-term and long-term result of histocompatibility examination of panel reactive antibody (PRA) before renal transplantation Methods PRA histocompatibility examination was performed in 854 patients before kidney transplantation, who were either PRA negative or PRA positive and underwent plasma exchange Four hunared and twenty-three patients not receiving PRA served as control The changes of immune variables, the ratio of acute rejection and the long-term survival rate were observed Results In control group, hyper-acute rejection occurred in 9 patients (2 1%), acute rejection in 198 patients (47%), and the patient/kidney survival rates were 86 7%/76 3% (for 1 year), 72 5%/67 9% (for 3 years) and 69 5%/49 3% (for 5 years), respectively In PRA group, no hyper-acute rejection occurred, and acute rejection was observed in 162 patients (19 0%), and the patient/kidney survival rates were 97 3%/95 0% (for 1 year), 92 0%/84 2% (for 3 years) and 87 0%/81 6% (for 5 years), respectively Conclusions Negative result of PRA examination before renal transplantation can eliminate hyper-acute rejection, decrease the ratio of acute rejection and improve patient/kidney survival rate