Zachary Andrea A, Hart John M, Lucas Donna P, Leffell Mary S
The Immunogenetics Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Clin Transpl. 2007:261-9.
We have shown that the number of HLA mismatched antigens correlates with the development of new or changes in existing HLA-specific antibodies. We have further shown that the magnitude of the effect varies among groups defined by whether or not HLA-specific antibody was present prior to transplant, by the transplant number, by recipient race, and by donor type. The increases in antibody, which increase with increasing degree of mismatch, result in differences in waiting times reflective of the number of previous mismatches. For many patients, increased waiting time represents not only reduced quality of life but deteriorating health and shortened life expectancy. Globally, increased waiting times translate into increased costs for dialysis, antibody testing, and health care. These factors suggest that HLA matching should not be abandoned but should be given consideration for those patients most affected by mismatches.
我们已经表明，HLA错配抗原的数量与新的HLA特异性抗体的产生或现有抗体的变化相关。我们还进一步表明，这种影响的程度在不同组之间有所不同，这些组是根据移植前是否存在HLA特异性抗体、移植次数、受者种族和供体类型来定义的。抗体的增加随着错配程度的增加而增加，这导致等待时间的差异，反映了先前错配的数量。对许多患者来说，等待时间的增加不仅意味着生活质量下降，还意味着健康状况恶化和预期寿命缩短。在全球范围内，等待时间的增加转化为透析、抗体检测和医疗保健成本的增加。这些因素表明，不应放弃HLA配型，而应考虑那些受错配影响最大的患者。
