Vereerstraeten P, Andrien M, de Pauw L, Dupont E, Goldman M, Abramowicz D, Kinnaert P
Département médico-chirurgical de Néphrologie, Dialyse et Transplantation, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Belgique.
Presse Med. 1991 Nov 27;20(40):1998-2000.
In a previous retrospective study conducted from 1980 to 1987 on 275 renal cadaveric transplants, we have shown that HLA-DR disparities between donor and recipient exerted differential effects on graft survival. Thus, the presence of DR4, DR5 and DR7 in the donor, or of DR5 in the recipient was associated with an excellent survival, whereas disparities due to the presence of DR1 and DR2 in the donor, or of DR2, DRw6 and DR7 in the recipient were detrimental for the graft. A prospective study on 158 renal cadaveric transplants performed from 1988 to 1990 yielded results that were similar to those of the retrospective study. Graft survival at 18 months was similar in recipients who had either the same DR antigens as those present in their donor or beneficial DR disparities only (83-90 percent), and significantly higher than in recipients with DR detrimental disparities only (62-65 percent). Graft survival in recipients with either mixed or neutral DR disparities occupied an intermediate position (77-78 percent). In conclusion, grafts with excellent outcome, similar to that observed in DR identical pairs, may be proposed to an ever increasing number of patients awaiting a renal transplant by adopting a selection policy based on the choice of beneficial DR disparities when a DR identical recipient is not available in the pool.
在1980年至1987年对275例尸体肾移植进行的一项回顾性研究中，我们发现供体和受体之间的HLA - DR差异对移植物存活有不同影响。因此，供体中存在DR4、DR5和DR7，或受体中存在DR5与良好的存活率相关，而供体中存在DR1和DR2，或受体中存在DR2、DRw6和DR7导致的差异对移植物是有害的。1988年至1990年对158例尸体肾移植进行的一项前瞻性研究得出了与回顾性研究相似的结果。在与供体具有相同DR抗原或仅存在有益DR差异的受体中，18个月时的移植物存活率相似（83% - 90%），且显著高于仅存在有害DR差异的受体（62% - 65%）。具有混合或中性DR差异的受体的移植物存活率处于中间位置（77% - 78%）。总之，当在等待肾移植的患者群体中没有DR相同的受体时，通过采用基于有益DR差异选择的策略，可以为越来越多的患者提供与DR相同配对中观察到的类似良好结果的移植物。
