术前群体反应性抗体对肾移植长期存活的影响

摘要

目的：：分析术前PRA水平与肾移植长期存活之间的关系。方法：收集我中心2001年1月至2014年6月间,接受首次肾移植术的1162例受者临床资料,根据受者术前PRA水平分组,将PRA≤10%分为阴性组,PRA>10%为阳性组,并对其进行回顾性分析。结果：术前 PRA 阴性者1、5、10年人存活率为96.8%、89.4%、78.6%,阳性者为93.5%、81.6%、65.4%,而术前PRA阴性者1、5、10年肾存活率为95.9%、84.8%、63.1%,阳性者为92.3%、74.1%、51.9%,两组移植人/肾间生存曲线均有统计学差异(人/肾log-rank检验χ2=9.623/11.019,P=0.002/0.001)。 Cox多因素回归分析显示PRA水平是影响人/肾存活的重要因素(P<0.001),PRA与术后急性排斥反应发生相关(OR=8.25,95% CI=2.86-5.72,P<0.001)。术前PRA阴性受者术后5年、10年血肌酐均较术前PRA阳性者低,具有统计学差异(P<0.05),而两者术后1年血肌酐无统计学差异。此外,PRA与术后抗供体特异性抗体(DSA)出现相关(OR=6.89,95% CI=4.52-9.17,P<0.05)。结论：PRA是肾脏移植术前筛选致敏受者的重要指标,术后更应注重PRA阳性受者急性排斥反应及DSA的监测和诊断。%Objective:To evaluate the effect of preoperative panel reactive antibody(PRA)levels on long-term survival after kidney transplantation. Methods:Data on 1 162 patients underwent first kidney transplantation performed between January 2001 and June 2014 were included in our center. According to the preoperative PRA levels,the patients were divided into negative group( PRA≤10%) and positive group( PRA>10%) ,which were retrospectively analyzed. Results: The 1-,5-,10-year patient survival rates of the negative group calculated by Kaplan-Meier were 96. 8%,89. 4%,78. 6%,respectively,while the positive group were 93. 5%,81. 6%, 65. 4%. The 1-,5-,10 -year death-censored graft survival rates of the negative group were 95. 9%,84. 8%,63. 1%,respectively,while the positive group were 92. 3%,74. 1%,51. 9%. The log-rank test revealed that there was significant difference between the patient and graft survival curves (χ2 =9. 623/11. 019, P=0. 002/0. 001 ) . Cox multivariate analysis found that preoperative PRA levels were independent risk factors for reducing the patient or graft survival rates(P<0. 001). Logistic multivariate regression analysis confirmed the significant association between preoperative PRA levels and the risk of acute rejection ( OR=8. 25,95% CI=2. 86-5. 72, P<0. 001). The 5-,10-year creatinine values were significantly lower in the negative group compared to the positive group(all P<0. 05), while there was no difference in the 1-year. In addition, Logistic multivariate regression analysis confirmed the significant association between preoperative PRA levels and the production of donor specific antibody(DSA)(OR=6. 89,95% CI=4. 52-9. 17,P<0. 05). Conclusion: The detection of preoperative PRA is an important indictor predicting the sensitivity status of the recipients. The preoperative PRA positive recipients need careful monitoring and diagnosis of acute rejection and DSA after kidney transplantation.