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目的 探讨人类白细胞抗原 (HLA)配型在致敏受者肾移植中的临床意义。方法 应用莱姆德细胞板通过补体依赖微量细胞毒性试验检测受者的群体反应性抗体 (PRA) ;应用单抗湿板进行供受者HLA Ⅰ类抗原分型 ;应用微量序列特异性引物 (Micro SSP)进行HLA Ⅱ类基因分型。结果 17例受者PRA阳性率为 5 .1%～ 80 % ,平均 37.9% ;按交叉反应组 (CREGs)配型原则 ,供受者HLACREGs 0 ,1和 2个错配 (MM)者分别为 5例 (2 9% )、8例 (4 7% )和 4例 (2 4% ) ,无 3～ 6个错配者 ;而按传统的HLA A ,B ,DR抗原配型原则 ,其 0 ,1和 2MM分别为 1例 (6 % ) ,1例 (6 % )和 8例 (4 7% ) ,3～ 4MM有 7例 (4 1% ) ;术后仅 3例发生急性排斥反应 ,经OKT3治疗后逆转 ,所有受者术后肾功能均恢复正常。结论 交叉反应组配型可显著提高供受者的HLA相配率 ;良好的HLA配型对减少致敏受者的肾移植排斥反应、提高移植物存活率具有重要意义
Objective To investigate the clinical significance of human leukocyte antigen (HLA) matching in sensitized recipients of kidney transplantation. Methods Reactive dendritic cells (PRA) were detected by complement-dependent microcytotoxicity assay in Lemd-cell plates. HLA class I antigens were genotyped by monoclonal antibody wet plate, and micro-sequence-specific primers (Micro SSP) for HLA class II genotyping. Results The positive rate of PRA in 17 patients was 5.1% ~ 80%, with an average of 37.9%. According to the CREGs matching criteria, 0, 1 and 2 mismatches (MM) of donor HLACREGs were 5 cases (29%), 8 cases (47%) and 4 cases (24%) had no 3 ~ 6 mismatches. According to the matching rules of HLA A, B and DR antigens, 0 (1%), 1 (6%) and 8 (47%) in 1 and 2 mm, 7 (4 1%) in 3 to 4 mm respectively; only 3 patients developed acute rejection after operation, After OKT3 treatment reversal, all recipients were returned to normal renal function. Conclusion Cross-reactive group matching can significantly improve donor HLA matching; good HLA matching is important for reducing renal allograft rejection and increasing graft survival in sensitized recipients