亲属肾移植患者术后肾功能与HLA配型和PRA相关性研究

摘要

目的 研究活体亲属肾移植受者人类白细胞抗原(human leukocyte antigen,HLA)配合率、群体反应性抗体(panelreactive antibody,PRA)的产生和肾功能变化对移植肾存活的影响.方法 将336例活体亲属肾移植患者分为5组:①父母给子女供肾组(118例).②子女给父母供肾组(12例).③兄弟姐妹间供肾组(107例).④其他亲属供肾组(92例).⑤夫妻间供肾组(7例).进行HLA供受者配合率分析,并于肾移植术后1-4年追踪肾功能变化和PRA产生的情况.HLA分型检测采用美国One lanmbda公司提供的HLA-PCR-SSP分型试剂盒.PRA采用美国莱姆德公司和美国GTI公司提供的酶联免疫吸附试剂盒检测.结果 第1组的118例肾移植供受者HLA-A、B、DR、DQ抗原单体型半相合,其中有22例抗原配合率高于单体型半相合.肾移植术后有36例患者出现肾功能下降,其中8例为PRA阳性.第2组的12例肾移植供受者HLA-A、B、DR、DQ抗原单体型半相合,其中有7例HLA抗原配合率高于单体型半相合.肾移植术后1例患者肾功能下降,且为再次肾移植患者.第3组的107例兄弟姐妹间HLA-A、B、DR、DQ配型完全相配合有18例,73例为单体型半相合或大于单体型半相合,其余为低于单体型半相合或不相合.肾移植术后中有13例患者肾功能下降,其中3例PRA阳性.第4组的92例其他亲属移植的供受者间HLA-A、B、DR、DQ等于或大于单体型半相合的有24例,完全不相合的有9例,虽然HLA抗原配合率大于4个抗原,但并不是单体型半相合抗原的有8例,等于或小于3个抗原配合的有51例.肾移植术后有11例患者肾功能下降,其中6例患者PRA阳性.第5组的7例夫妻间肾移植患者,HLA配合率均≤3个抗原.肾移植术后有2例患者肾功能下降,且为PRA阳性.结论 父母、子女及兄弟姊妹等直系亲属肾移植供受者中HLA配合率高于其他亲属间移植供受者,但兄弟姊妹间HLA配型完全相同的则较低.HLA配型与近期移植肾存活无关,而与供者的年龄有关.良好的HLA配型与肾移植术后PRA生成的概率低有关.%Objective To investigate correlation of posttransplant renal function with HLA typing and panel reactive antibody ( PRA) in related living donor renal transplantation recipients. Methods Data from 336 patients who received living renal transplantation in our hospital, were analyzed. PRA, serum creatinine and urea nitrogen level were detected 1-4 years after transplantation. The donations were classified 5 groups: ①Parents donated to sons and daughters;② Sons and daughters donated to parents; ③ Donation between brothers and sisters; ④ others;⑤ Donation between husbands and wives. HLA-PCR-SSP kits were provided by One Lanmbda Company. PRA in recipients was detected by enzyme-linked immune absorbent assay. Results In group 1 118 recipients shared half-match HLA-A, B, DR, DQ with donors, 22 patients had more than half match; 36 recipients' renal function decreased and 8 patients PRA antibody positive post-transplantation. In group 2 12 recipients shared half-match HLA-A, B, DR, DQ with donors, 7 recipients more than half-match; 1 recipient had renal function decrease and underwent transplantation for the second time. In group 3, of 107 recipients, 18 recipients shared the same HLA-A, B, DR, DQ typing with donors, 73 recipients had more than half-match or half-match, others lower half-match or mismatch; 13 recipients renal function decreased and 3 recipients were PRA antibody positive post-transplantation. In group 4, of 92 recipients, 24 shared half-match with donors, 9 recipients were mismatched, although HLA typing matched for more than 4 antigens, 8 recipients had non-half-match, 51 recipients had 3 antigens or less match; 11 recipients had renal function decrease and 6 recipients PRA antibody positive in post-transplantation. In group 5 all the 7 recipients had HLA typing rate less 3 antigens; 2 recipients renal function decreased and PRA antibody positive post - transplantation . Conclusion The rate of matched HLA typing between the immediate familymembers was higher than that in other relative donation, however, the rate of completely matched HLA typing was lowerbetween brothers and sisters. There was no correlation between HLA typing and renal allograft function in the near future,but HI .A typing was relevant to donor' age. Well-matched HLA typing was correlated with low level PRA post renaltransplantation.