肾移植受者术前群体反应性抗体筛查探讨

摘要

目的 探讨肾移植受者术前群体反应性抗体(PRA)监测对移植肾存活及急性排斥反应发生率的影响.方法 回顾性分析2003年4月至2009年12月于该院行肾移植术的患者共计1 430例次,根据术前PRA检测结果分为阴性组(PRA<10%)和致敏组(PRA≥10%),分析两组间术后一年急性排斥反应发生率和肾存活率的差异;结合临床资料,对输血、妊娠、移植术史等致敏相关因素进行分析.结果 肾移植受者术前PRA阳性率为15.0%,不同性别阳性率差异有统计学意义(P=0.029);阴性组和致敏组急性排斥反应发生率分别为25.1%和49.2%,一年肾存活率分别为97.1%和92.1%,差异均有统计学意义(P=0.000和P=0.004).结论 PRA阳性是移植肾存活和急性排斥发生的危险因素,输血、多次妊娠、有移植史可导致受者PRA阳性;避免供受者间的HLA位点错配和减少输血是降低PRA阳性率的有效手段.%Objective Discussing the effect of monitoring preoperative renal transplant recipients reactive antibody (PRA) on survival of renal transplant and acute rejection rate. Methods Using retrospective analysis of 1 076 cases of kidney transplantation recipients applied ELISA method to test PRA from April 2003 to December 2009 in our hospital 1 430 times. And they are divided into PRA-negative group and the sensitizing group according to PRA levels (＜10％ and ≥ 10％). Collecting and analyzing the differences of survival of renal transplant and acute rejection rate between two groups during one year,after combination of clinical data, related sensitizing factors such as blood transfusions, pregnancy, history of transplantation are analyzed. Results PRA positive rate of preoperative renal transplant recipients is 15.0％ ,and positive rate of different sexes is statistically significant (P=0. 029);The acute rejection rate of PRA-negative group and the sensitizing group is respectively 25.1％ and 49.2％, and kidney survival rates after one year are 97.1 ％ and 92.1 ％ ,which are statistically significant (P=0. 000 and P=0. 004). Conclusion PRA positive is a risk-causing factor in survival of renal transplant and acute rejection rate. And blood transfusion, multiple pregnancy, history of transplant can lead to positive PRA of the recipients;Avoiding HLA locus mismatch between donors and recipients and reduction of transfusion are the effective means to reduce PRA positive rate.