流式细胞仪交叉配型对移植肾1年存活率的影响

目的：探讨流式细胞仪交叉配型（flow cytometry crossmatch, FCXM）对移植肾一年存活率的影响。方法:应用χ2检验比较FCXM阳性与阴性组间1年移植肾死亡有无差异。以“移植后1年肾脏的存活状况(是/否)”为应变量，以移植后早期排斥反应（移植后1月内发生）、血管性排斥反应、移植肾功能延迟（移植后1周内需做血液透析）、FCXM、群体抗原反应抗体(PRA)、 HLA A,B配型、HLA DR配型、供者类型（尸肾/活体供肾）、既往移植次数、免疫抑制药物的使用、血清巨细胞病毒状态、冷缺血时间、供者和受者年龄等可疑影响因素为自变量建立Logistic回归模型，探讨流式细胞仪交叉配型对移植肾1年存活有无影响。结果:258例患者平均随访时间为25个月（12～60个月），期间30例移植肾死亡，其中23例发生在移植后1年内。 χ2检验显示，FCXM阳性与阴性组间1年移植肾死亡无统计学差异（P=0.157?0）。 Logistic 回归显示，对移植肾1年死亡有影响的因素包括移植肾功能延迟（OR=8.00, P=0.001?4），供者类型为尸肾（OR=9.30, P=0.001?7）和血管排斥反应（OR=5.05, P=0.021?9）。FCXM的结果不会影响移植肾一年存活率（OR=1.60, P=0.534?6）。结论: FCXM对移植肾1年后存活尚无肯定的影响。

Predictive value of flow cytometry crossmatch to one-year graft loss following kidney transplantation

Objective: Flow cytometry crossmatch (FCXM) has been extensively used in kidney transplantation, but there is no agreement regarding its predictive value for one year graft loss following kidney transplantation. The aim of the study was to explore the relationship between FCXM and one year graft loss following kidney backward stepwise method. Results: Graft loss occurred in 30 subjects during the follow up, and 23 graft losses happened in the first year following kidney transplantation. χ2 test showed that there was no statistical difference regarding one year graft loss between FCXM positive and negative groups. Logistic regression showed that the significant predictors for one year graft loss were delayed graft function (OR=8.00, P=0.001?4), cadaver donor (OR=9.30, P=0.001?7) and vascular rejection (OR=5.05, P=0.021?9). FCXM was not a significant predictor with an odds ratio of 1.60 (P=0.534?6). Conclusion: FCXM has no predictive value for one year graft loss following kidney transplantation.transplantation. Methods: χ2 test was used to compare one year graft loss rate between FCXM positive and negative groups. Logistic model was built to measure the association between flow cytometry crossmatch and one year graft loss, and model variables included early acute rejection, vascular rejection, delayed graft function, positive FCXM, panel reactive antibody, HLA A, B mismatch number, HLA DR mismatch number, donor resource, transplantation history, cold ischemic time, donor and recipient age and immunosuppression medication. The final model was determined by th