群体反应性抗体在预测尸体肾移植受者交叉配型选择中的作用。

Effect of panel-reactive antibody in predicting crossmatch selection of cadaveric kidney recipients.

作者信息

Lieber S R, Perez F V T, Tabossi M R, Persoli L B L, Marques S B D, Mazzali M, Alves-Filho G, de Souza C A

机构信息

Campinas State University, Hematology and Hemotherapy Center, Campinas State University, Campinas, São Paulo, Brazil.

出版信息

Transplant Proc. 2007 Mar;39(2):429-31. doi: 10.1016/j.transproceed.2007.01.045.

DOI:10.1016/j.transproceed.2007.01.045

PMID:17362748

Abstract

AIM

The influence of panel-reactive antibody level (%PRA) on crossmatch results was evaluated among 866 patients on the waiting list for cadaveric renal allografting from January 2001 to August 2005. We evaluated the results for 124 potential donors for a kidney, including 2008 crossmatches. Four hundred eighteen patients were tested against only 1 donor.

METHODS

Serum samples were screened for anti-HLA antibodies using immunoglobulin (Ig)G enzyme-linked immunosorbent assay (ELISA) PRA kit and the %PRA of the most reactive sample (peak) was used for patient stratification, according to sensitization level. Crossmatches were performed on fresh donor T lymphocytes from peripheral lymph nodes, using classical and anti-human-globulin enhanced complement-dependent cytotoxicity (CDC-T) methods. The tests were performed using peak and current patient sera before and after dithiothreitol treatment. The crossmatch was assumed to be negative when no reactivity was observed in all tests.

RESULTS

The incidences of positive crossmatch were as follows: 72.3%, 14.6%, and 7.2%, among patients with PRA >50%, PRA </=50%, and PRA = 0%, respectively. A negative crossmatch was observed in 6.5% (4 of 62) of the tests among 100% PRA patients.

CONCLUSION

Although %PRA level reflects the HLA sensitization of the patient, IgG ELISA PRA and CDC-T crossmatch may not reflect the same antibodies, and both results must be considered in a transplantation decision.

摘要

目的

评估2001年1月至2005年8月期间866例尸体肾移植等待名单上患者的群体反应性抗体水平（%PRA）对交叉配型结果的影响。我们评估了124名潜在肾脏供者的结果，包括2008次交叉配型。418例患者仅与1名供者进行了检测。

方法

使用免疫球蛋白（Ig）G酶联免疫吸附测定（ELISA）PRA试剂盒筛查血清样本中的抗HLA抗体，并根据致敏水平将反应性最强样本（峰值）的%PRA用于患者分层。采用经典法和抗人球蛋白增强补体依赖细胞毒性（CDC-T）法对来自外周淋巴结的新鲜供者T淋巴细胞进行交叉配型。检测使用二硫苏糖醇处理前后的峰值和当前患者血清进行。当所有检测均未观察到反应性时，交叉配型被判定为阴性。