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目的:探讨人类白细胞抗原(HLA)氨基酸残基配型(Res M)标准在高致敏尿毒症患者肾移植中的应用。方法:在动态监测群体反应性抗体(PRA)水平、特异性及淋巴毒交叉配合试验的基础上,采用ResM标准选取与供者最匹配的供体。结果:56例尿毒症患者术前PRA均大于20%,采用Terasaki提出的ResM标准,供受者0抗原错配(MM)为6例(10.7%),1MM为13例(23.2%),2MM为19例(33.9%),3MM为13例(23.2%),4MM为5例(9.1%),5MM和6MM为0例。术后56例受者均未发生超急性排斥反应,17例(30.4%)发生急性排斥,经甲基强的松龙冲击治疗后3例(5.4%)切除移植肾,另14例(25%)排斥反应逆转,肾功能恢复。5例(8.9%)发生移植物功能延迟恢复(Delay Graft Function,DGF),经血液透析过渡治疗后均在5周内恢复。结论:Res M标准可提高PRA阳性受者与供者之间HLA相配程度,缩短患者等肾时间,降低排斥反应的发生率,是一种有效的、具有临床实用价值的配型策略。
Objective: To investigate the application of human leucocyte antigen (HLA) amino acid residue matching (Res M) standard in renal transplantation in patients with hypersensitive uremia. Methods: On the basis of the dynamic monitoring of PRA level, specificity and lymphoid cross-mating test, the most suitable donors were selected by ResM standard. Results: The preoperative PRA in 56 uremic patients was more than 20%. According to the ResM standard proposed by Terasaki, there were 6 patients (10.7%) with 0 antigen mismatch (MM), 13 patients (23.2%) with 1MM, 19 cases (33.9%), 3MM was 13 cases (23.2%), 4MM was 5 cases (9.1%), 5MM and 6MM were 0 cases. None of the 56 postoperative patients had hyperacute rejection and 17 (30.4%) had acute rejection. Three patients (5.4%) were treated with methylprednisolone and the other 14 patients (25% Rejection rejection, renal function recovery. Delayed graft function (DGF) occurred in 5 cases (8.9%) and recovered within 5 weeks after hemodialysis transition. Conclusion: The Res M standard can improve HLA matching between PRA-positive recipients and donors, shorten the time of waiting for patients and reduce the incidence of rejection, and is an effective and clinically valuable matching strategy.