Smith J D, Danskine A J, Rose M L, Yacoub M H
Department of Immunology, Harefield Hospital, Middlesex, England.
Transplantation. 1992 Jun;53(6):1358-62. doi: 10.1097/00007890-199206000-00034.
Eighty-two patients have been studied to determine the class and specificity of lymphocytotoxic antibodies produced during the 6 months following cardiac transplantation. Weekly serum samples were monitored for panel-reactive lymphocytotoxic antibodies (PRA) and donor reactive lymphocytotoxic antibodies using dithiothreitol to determine immunoglobulin class. Sera containing donor-reactive antibodies were further analyzed in a cytotoxic inhibition assay to determine whether the antibodies were directed against HLA or non-HLA determinants. A total of 67 (82%) of the patients produced detectable PRA following transplantation, no correlation was found between PRA and the incidence and severity of rejection. In 33 cases where an HLA specificity was defined, the antibody was not directed against the donor HLA phenotype. In contrast, the 32 (53%) recipients who had formed donor-reactive antibodies within 6 months of operation had required significantly more antirejection therapy (methylprednisolone) than the crossmatch-negative recipients (P less than 0.01). This was the case for both IgG and IgM responses. Of 24 positive donor responses, 18 were found to be specific for HLA antigens. These were both IgM (6 cases) and IgG (12 cases) HLA-specific antibodies, and their occurrence was strongly correlated with rejection (P less than 0.001).
对82例患者进行了研究，以确定心脏移植后6个月内产生的淋巴细胞毒性抗体的类别和特异性。每周采集血清样本，使用二硫苏糖醇检测群体反应性淋巴细胞毒性抗体（PRA）和供体反应性淋巴细胞毒性抗体，以确定免疫球蛋白类别。对含有供体反应性抗体的血清进行细胞毒性抑制试验进一步分析，以确定抗体是否针对HLA或非HLA决定簇。共有67例（82%）患者在移植后产生了可检测到的PRA，未发现PRA与排斥反应的发生率和严重程度之间存在相关性。在33例确定了HLA特异性的病例中，抗体并非针对供体HLA表型。相比之下，32例（53%）在手术6个月内形成供体反应性抗体的受者比交叉配型阴性的受者需要显著更多的抗排斥治疗（甲基泼尼松龙）（P<0.01）。IgG和IgM反应均如此。在24例供体反应阳性中，18例被发现对HLA抗原具有特异性。这些是IgM（6例）和IgG（12例）HLA特异性抗体，它们的出现与排斥反应密切相关（P<0.001）。
