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目的:探讨人类白细胞抗原(HLA)配型和抗HLA抗体检测在亲属活体肾移植的应用,及其与移植效果的关系。方法:移植受者及其亲属供体采用PCR-SSP进行HLA配型,移植术前行补体依赖微量细胞毒性试验(CDC)交叉配型,同时采用酶联免疫吸附(ELISA)方法筛查和监测受者的群体反应性抗体(PRA)。分析亲属活体供肾移植的临床效果。结果:66例受者接受了亲属活体供肾移植手术。63例术前抗HLA抗体检测为阴性,其中供受者HLA配型错配(MM)者0~3 MM受者57例,3例(5.26%)发生肾功能延迟恢复(DGF),2例(3.51%)发生急性排斥(AR);HLA 4~6 MM受者6例中分别有1例(16.67%)和2例(33.33%)发生DGF和AR。HLA 0~3 MM组AR发生率显著性低于4~6 MM组(P<0.05)。而不同临床免疫抑制方案组之间AR发生率无显著性统计学差异(P>0.05)。甲基泼尼松龙(MP)和抗人胸腺细胞球蛋白(ATG)冲击等治疗措施后,所有AR得以逆转。3例术前预致敏(PRA 35%~87.5%)的受者,HLA 2~3 MM。1例致敏受者肾功能顺利恢复,PRA维持不变。另2例致敏受者术前自然或经血浆置换后PRA转阴,术后发生AR,ATG冲击治疗后肾功能也恢复正常,抗体有轻度反弹。结论:亲属活体供肾移植的组织配型良好,配合抗HLA抗体监测,使得受者移植的机会增加,排斥反应发生率低,但错配者多,术前致敏受者排斥反应发生率高,应加强围手术期处理。
Objective: To investigate the application of human leukocyte antigen (HLA) matching and anti-HLA antibody detection in relative living donor kidney transplantation and its relationship with transplantation efficacy. Methods: The recipients and their relatives were HLA-matched by PCR-SSP. The complement-dependent microtiter cytotoxicity test (CDC) cross-matching was performed before transplantation. The patients were screened and monitored by enzyme-linked immunosorbent assay (ELISA) Recipient population reactive antibody (PRA). Analysis of the clinical effect of living donor kidney transplantation. RESULTS: Sixty-six patients underwent donor living donor kidney transplantation. 63 cases of preoperative anti-HLA antibodies were negative, of whom 57 cases received 0-3 MM recipients with HLA mismatch (MM), 3 cases (5.26%) had delayed renal function recovery (DGF) and 2 cases (3.51%) had acute rejection (AR); DGF and AR occurred in 1 of 6 (16.67%) and 2 (33.33%) of HLA-4 to 6 MM recipients, respectively. The incidence of AR in HLA 0 ~ 3 MM group was significantly lower than that in 4 ~ 6 MM group (P <0.05). There was no significant difference in the incidence of AR between different clinical immunosuppressive regimens (P> 0.05). All AR were reversed after treatment with methylprednisolone (MP) and anti-human thymocyte globulin (ATG) shock. Three pre-sensitized recipients (PRA 35% -87.5%) received HLA 2 ~ 3 MM. One case of allergic renal function recovered, PRA remained unchanged. The other two cases of sensitized recipients were treated with PRA either before or after plasma exchange, and renal function returned to normal after AR and ATG were treated. Antibody slightly rebounded. Conclusion: Relatives of living donor kidney transplantation with good tissue matching, combined with anti-HLA antibody monitoring, making the recipients increased opportunities for transplantation, the incidence of rejection is low, but more mismatch, preoperative sensitization recipients with high incidence of rejection , Should be strengthened perioperative management.