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目的评价肾移植术后特异性人类白细胞抗原(HLA)-Ⅱ类抗体对移植肾长期存活的影响。方法采用前瞻性队列研究,通过酶联免疫吸附(ELISA)法检测118例。肾移植患者围手术期特异性 HLA-Ⅱ类抗体水平,随访观察抗体对移植肾长期存活的影响。结果 (1)生存分析提示HLA-Ⅱ类抗体阳性组第3、第4年移植肾存活率明显低于抗体阴性组(第3年:78.6% vs 84.4%,第4年:71.4% vs 80.0%,P=0.002);排除受者死亡因素后,HLA-Ⅱ类抗体阳性组移植肾存活率仍然低于抗体阴性组(第3年:85.7% vs 92.2%,第4年:82.1% vs 90.O%,P=0.003)。(2)HLA-Ⅱ类抗体阳性组患者第3、第4年移植肾功能下降的比例高于抗体阴性组(第3年:39.3% vs 33.3%,第4年:46.4% vs 38.9%,P=0.001)。(3)HLA-Ⅱ类抗体阳性组和阴性组比较,晚期急性排斥发生率的差异无统计学意义(10.7% vs 13.3%,P>0.05)。结论术后特异性 HLA-Ⅱ类抗体可能是影响移植肾长期存活的的重要因素之一,移植后 HLA-Ⅱ类抗体水平的动态变化可以从一个侧面反映移植肾的预后情况。
Objective To evaluate the effect of specific human leukocyte antigen (HLA) Ⅱ antibody on the long-term survival of renal allografts after kidney transplantation. Methods By prospective cohort study, 118 cases were detected by enzyme-linked immunosorbent assay (ELISA). The level of perioperative HLA-class II antibody in renal transplant recipients was observed and the effect of antibody on the long-term survival of renal allografts was observed. Results (1) Survival analysis showed that the survival rate of renal allografts in the third and fourth year of HLA-Ⅱ antibody positive group was significantly lower than that of the antibody negative group (the third year: 78.6% vs 84.4%, the fourth year: 71.4% vs 80.0% , P = 0.002). After excluding the cause of death, the survival rate of graft-versus-host mice in HLA-Ⅱ antibody positive group was still lower than that in antibody negative group (85.7% vs 92.2% in the third year and 82.1% vs 90% in the fourth year. O%, P = 0.003). (2) The proportion of renal function decline in the third and fourth year of HLA-Ⅱ antibody-positive group was higher than that of antibody negative group (39.3% vs 33.3% in the third year, 46.4% vs 38.9% in the fourth year, P = 0.001). (3) There was no significant difference in the incidence of late acute rejection between HLA-Ⅱ antibody positive group and negative group (10.7% vs 13.3%, P> 0.05). Conclusion The postoperative HLA-Ⅱ antibody may play an important role in long-term graft survival. The dynamic changes of HLA-Ⅱ antibody level after transplantation may reflect the prognosis of transplant recipients.