肾移植后急性体液排斥反应：5年同一机构296例随访*

背景：肾移植后急性体液排斥反应虽然发生率不高,但对移植物功能恢复可造成严重影响,是移植物早期丢失的主要原因。 目的：分析肾移植后急性体液排斥反应早期诊断和防治的意义。 方法：选择接受肾移植后规律随访的受者296例,其中移植前群体反应性抗体阳性受者26例,阴性受者270例。酶联免疫吸附试验动态监测肾移植受后外周血中的群体反应性抗体和供者特异性抗体,免疫组织化学染色观察穿刺活检组织中C4d的沉积及浸润淋巴细胞表面分子标记,按Banff 2005标准结合临床相关指标诊断急性体液排斥反应。 结果与结论：26例移植前群体反应性抗体阳性受者中6例(23%)移植后发生了急性体液排斥反应,270例阴性受者中19例(7%)发生了急性体液排斥反应,差异有显著性意义(P < 0.01)。发生急性体液排斥反应的患者中22例(88%)外周血清中检测到供者特异性抗体,271例无急性体液排斥反应的患者中仅1例检出供者特异性抗体,差异具有显著性意义(P < 0.01)。急性体液排斥反应受者中C4d阳性率为80%,未发生急性体液排斥反应的患者C4d阳性率仅为6.7%,差异具有显著性意义(P < 0.001)。肾移植后早期监测群体反应性抗体和供者特异性抗体水平,通过穿刺活检观察移植肾组织中的C4d沉积情况,可及时诊断急性体液排斥反应,有效改善移植物功能并提高移植物存活率。关键词：肾移植;供者特异性抗体;急性体液排斥反应;C4d;利妥昔单抗  doi:10.3969/j.issn.1673-8225.2012.18.005 中图分类号: R617  文献标识码: A   文章编号: 1673-8225(2012)18-03249-06

Acute humoral rejection after renal transplantation Five-year follow-up of 296 cases from one organization*

BACKGROUND: The incidence of acute humoral rejection following renal transplantation is not high, but it can injure allograft severely and lead to dysfunction, and is considered the leading cause of early loss of the grafts. OBJECTIVE: To investigate the significance of early diagnosis and prevention of acute humoral rejection after renal transplantation. METHODS: A total of 296 patients were subjected to regular follow-up following renal transplantation, prior to the surgery,   26 patients were positive for panel reactive antibodies and 270 were negative. The dynamic changes of panel reactive antibodies and donor specific antibodies in peripheral blood were monitored by enzyme-linked immunosorbent assay. C4d deposition and molecular markers of infiltrating lymphocytes in biopsy tissue were observed by immunohistochemistry. The acute humoral rejection was diagnosed according to Banff 2005 criteria and clinical related indexes. RESULTS AND CONCLUSION: After transplantation, acute humoral rejection was diagnosed in six cases (23%) out of 26 positive patients and in 19 cases (7%) out of 270 negative patients for panel reactive antibodies. The difference of incidence rates between positive and negative patients was significant (P < 0.01). Donor specific antibodies were detected in peripheral serum of 22 patients (88%) who had developed acute humoral rejection and in 1 patient among the other 271 recipients without acute humoral rejection, with significant difference (P < 0.01). 80% of acute humoral rejection patients and 6.7% of non-acute humoral rejection patients were C4d positive. There were significant differences in the C4d positive rates between acute humoral rejection patients and non-acute humoral rejection patients (P < 0.001). Early monitoring of panel reactive antibodies and donor specific antibodies after transplantation, together with C4d deposition in biopsy tissue, may help to timely diagnose acute humoral rejection, and effectively improve the functions and survival rate of allograft.