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目的探讨致敏肾移植患者体内预存抗HLA抗体的特异性及其HLA配型。方法以酶联免疫吸附试验动态监测136例群体反应性抗体(PRA)阳性的肾移植患者手术前后IgG型抗HLA抗体的水平及其特异性。应用抗HLAⅠ类单克隆抗体湿板进行供、受者HLAⅠ类抗原分型,微量序列特异性引物法进行供、受者HLAⅡ类基因分型,根据HLAⅠ类抗原交叉反应组(CREGs)配型标准和Ⅱ类抗原可接受性错配原则进行供、受者选配。结果136例中,104例存在抗HLAⅠ类IgG抗体,76例存在抗HLAⅡ类IgG抗体,44例同时存在抗HLAⅠ类和Ⅱ类IgG抗体。按照传统HLA抗原配型标准,136例中,供、受者HLA抗原无错配、1个抗原错配、2个抗原错配、3个抗原错配、4个抗原错配者分别为7例(5．1%)、26例(19．1%)、47例(34．6%)、39例(28．7%)和17例(12．5%)；而按照CREGs配型标准,HLA抗原无错配、1个抗原错配、2个抗原错配、3个抗原错配者分别为31例(22．8%)、53例(39．0%)、36例(26．5%)和16例(11.7%),没有4个抗原错配者。按照CREGs配型原则,HLA抗原无错配者的急性排斥反应发生率明显低于2个和3个抗原错配者(P＜0．05),其移植肾1、3、5年存活率明显高于2个和3个抗原错配者。结论根据CREGs配型标准能够显著提高供、受者的相配率；良好的HLA配型可降低排斥反应的发生率,提高移植肾的存活率。
Objective To investigate the specificity and HLA typing of pre-stored anti-HLA antibodies in sensitized kidney transplant recipients. Methods The level and specificity of anti-HLA antibodies of 136 anti-HLA antibodies in 136 PRA-positive renal transplant recipients before and after surgery were dynamically monitored by enzyme linked immunosorbent assay (ELISA). HLA class I antigens were genotyped by using anti-HLA class I monoclonal antibody wet plate, HLA class II genotypes were obtained by micro-sequence-specific primer method. According to the HLA class I antigen cross-reactivity group (CREGs) And class Ⅱ antigen acceptability mismatch principle for the recipient matching. Results Of the 136 cases, 104 cases had anti-HLA class I IgG antibodies, 76 cases had anti-HLA class II IgG antibodies and 44 cases had both anti-HLA class I and class II IgG antibodies. According to the traditional HLA antigen matching standard, 136 patients, donors and recipients without HLA antigen mismatch, an antigen mismatch, two antigen mismatch, three antigen mismatch, four antigen mismatch were 7 cases (5.1%), 26 cases (19.1%), 47 cases (34.6%), 39 cases (28.7%) and 17 cases (12.5%). According to the CREGs matching standard, There were 31 cases (22.8%), 53 cases (39.0%) and 36 cases (26.5%) with HLA mismatch, 1 mismatch antigen and 2 antigen mismatches, respectively %) And 16 cases (11.7%), no 4 antigen mismatch. According to the CREGs matching principle, the incidence of acute rejection without HLA antigen mismatch was significantly lower than 2 and 3 antigen mismatches (P <0.05), and the survival rate at 1, 3 and 5 years after transplantation was significant Higher than 2 and 3 antigen mismatches. Conclusion According to CREGs matching standard can significantly improve the donor and recipient matching rate; good HLA matching can reduce the incidence of rejection and improve graft survival.