【摘要】 目的探讨HLA交叉反应组(CREGs)配型对群体反应性抗体(PRA)阳性肾移植受者人/肾存活率的影响。方法应用美国莱姆德公司LAT1240、LM72OR、SSP2LB试剂,准确检测112例PRA阳性肾移植受者体内PRA的水平及其抗体的特异性,评估其致敏状态,应用CREGs配型标准选择最匹配的供者。结果112例受者中,HLA-Ⅰ类抗体阳性43例,Ⅱ类抗体阳性39例,Ⅰ、Ⅱ类抗体均为阳性30例;HLA配型0～5个位点错配数分别为6、39、38、21、7、1例,术后移植肾发生加速性排斥反应2例、急性排斥反应18例、慢性排斥反应5例、移植肾功能延迟恢复(DGF)4例,因排斥反应导致移植肾切除1例,死亡13例(其中移植肾带功能死亡5例)。目前人存活99例,肾存活96例,5年、3年和1年肾存活率分别为86.21%、86.96%和91.96%。结论运用CREGs配型原则,能使供、受者间的HLA相配率显著提高,可减少PRA对肾移植的不良影响,提高PRA阳性受者的人/肾存活率。更多还原

【Abstract】 Objective To elucidate the effect of human leukocyte antigen(HLA)cross-reactive groups(CREGs)matching on the patient/graft survival rate of renal transplant recipients positive for penal-reactive antibody(PRA).Methods The PRA level and the HLA antibody specificity of renal transplant candidates were assayed using the LAT1240,LM720R,and SSP2LB kits.The appropriate donors were selected according to the CREGs matching standard.Results 112 recipients included 43 positive cases of HLA classⅠantibody,39 positive cases of HLA classⅡantibody,and 30 positive cases of bothⅠandⅡ.The HLA mismatching cases of 0,1,2,3,4 and 5 allele(s)were 6,39,38, 21,7 and 1,respectively.Hyper-acute rejection(2 cases),acute rejection(18 cases),chronic rejec- tion(5 cases),delayed graft function(4 cases),graft excision(one case)due to rejection and deaths (13 cases,5 with a functioning graft)occurred after transplant.Ninety-nine recipients and 96 grafts survived.The 1-,3-,and 5-year graft survival rate was 91.96%,86.96%,and 86.21%,respec- tively.Conclusion The HLA matching rate of patient/graft was elevated significantly and the effect of high PRA level was decreased according to the principle of CREGs,which increased the patient/graft survival rate remarkably in sensitized recipients.更多还原