来自尸体供者的全国共享、HLA配型相合肾移植的存活情况。美国器官共享联合网络科学肾脏移植登记处。

Survival of nationally shared, HLA-matched kidney transplants from cadaveric donors. The UNOS Scientific Renal Transplant Registry.

作者信息

Takemoto S, Terasaki P I, Cecka J M, Cho Y W, Gjertson D W

机构信息

Department of Surgery, University of California, Los Angeles 90024.

出版信息

N Engl J Med. 1992 Sep 17;327(12):834-9. doi: 10.1056/NEJM199209173271202.

DOI:10.1056/NEJM199209173271202

PMID:1508242

Abstract

BACKGROUND

The importance of HLA histocompatibility typing to the outcome of transplantation of cadaveric kidneys has been controversial. Four years ago, a prospective trial began in all U.S. transplantation centers to determine whether the results of transplantation would improve with the nationwide shipment of kidneys from cadaveric donors to waiting patients undergoing dialysis when there was a match at the HLA-A, B, and DR loci.

METHODS

A total of 1386 cadaveric kidneys were shipped from 108 organ centers to 198 transplantation centers and distributed among HLA-matched recipients, 1004 of whom were receiving a first transplant and 382 of whom were receiving a subsequent transplant. Graft survival in these recipients was compared with that in 22,188 recipients of first transplants and 3950 recipients of subsequent transplants whose HLA antigens differed from those of the donor.

RESULTS

The rate of graft survival at one year in recipients of HLA-matched first transplants was 88 percent, as compared with 79 percent in the recipients of mismatched grafts (P less than 0.001). The estimated half-life of the kidney after the first year was 17.3 years for matched grafts, as compared with 7.8 years for mismatched grafts (P = 0.003). Among paired kidneys from 470 donors, one-year graft survival was 87 percent in the recipients of matched first grafts, as compared with 80 percent in the recipients of the contralateral kidneys, who did not have HLA matches with the donors. In donors and recipients matched for the more highly defined split Class I and Class II HLA antigens, the rate of graft survival after one year was as high as 90 percent.

CONCLUSIONS

The collaborative renal-transplantation program for HLA matching of donors and recipients yielded an increased rate of one-year graft survival and an estimated half-life for matched grafts twice that for mismatched grafts. An increased role for HLA matching in kidney allocation is therefore indicated.

摘要

背景

HLA组织相容性分型对尸体肾移植结果的重要性一直存在争议。四年前，一项前瞻性试验在美国所有移植中心展开，以确定当尸体供体的肾脏与接受透析的等待患者在HLA - A、B和DR位点相匹配时，通过全国范围的肾脏运送，移植结果是否会得到改善。

方法

总共1386个尸体肾从108个器官中心运送到198个移植中心，并分配给HLA匹配的受者，其中1004人接受首次移植，382人接受再次移植。将这些受者的移植物存活率与22188例首次移植受者和3950例再次移植受者的移植物存活率进行比较，这些受者的HLA抗原与供体不同。

结果

HLA匹配的首次移植受者一年时的移植物存活率为88%，而不匹配移植物受者为79%（P<0.001）。匹配移植物在第一年之后的肾脏估计半衰期为17.3年，而不匹配移植物为7.8年（P = 0.003）。在来自470名供体的成对肾脏中，匹配的首次移植受者一年移植物存活率为87%，而对侧肾脏受者为80%，后者与供体没有HLA匹配。在供体和受者的更精细定义的I类和II类HLA抗原匹配的情况下，一年后的移植物存活率高达90%。