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目的 :探讨检测人类白细胞抗原 (HLA)和群体反应性抗体 (PRA)对肾移植高敏受者的临床意义。 方法 :应用莱姆德细胞板动态监测受者的PRA ,判断其HLA免疫致敏状态 ;应用单克隆抗体湿板进行供、受者HLA Ⅰ、Ⅱ类抗原分型。 结果 :9例受者PRA阳性率为 41%～ 84% ,平均 5 5 % ;按交叉反应组 (CREGs)配型原则 ,本组受者中 0 ,1和 2个HLA A、B、DR抗原错配 (mismatch ,MM)者分别为 3例 (33% )、4例 (45 % )和 2例 (2 2 % ) ,与传统的HLA配型原则比较 ,其中 0MM和 1MM受者分别增加了 2 2 %和 34 % ;术后仅 2例发生急性排斥反应 ,经OKT3治疗后逆转 ;无超急排斥反应发生。所有受者术后肾功能均恢复正常。 结论 :应用交叉反应组配型原则可显著提高供受者HLA相配率 ;良好的HLA配型对减少高敏受者的排斥反应、提高移植物存活率具有重要意义。
Objective: To investigate the clinical significance of detection of human leukocyte antigen (HLA) and population reactive antibody (PRA) in high-sensitivity renal transplant recipients. Methods: The PRA of recipient was dynamically monitored by Lemder cell plate, and the status of HLA immune sensitization was determined. The monoclonal antibody wet plate was used to supply HLA class I and type II antigens. Results: The positive rate of PRA was 41% -84% in 9 cases, with an average of 55%. According to the principle of CREGs distribution, 0, 1 and 2 HLA A, B and DR antigens Mismatch (MM) were 3 cases (33%), 4 cases (45%) and 2 cases (2 2%) respectively. Compared with the traditional HLA matching principle, 0MM and 1M recipients increased 2 2% and 34% respectively. Only 2 cases developed acute rejection after OKT3 treatment, and no hyperacute rejection occurred. All recipients returned to normal renal function. Conclusion: The principle of cross-reactive group matching can significantly improve donor HLA matching rate; good HLA matching is of great significance to reduce the rejection of hypersensitive recipients and improve the graft survival rate.