Sutherland F R, Leckie S H, Ostbye T, Howson W T, Sengar D P, Lazarovits A I
Department of Medicine, University Hospital, London, Ontario.
Clin Invest Med. 1991 Apr;14(2):120-4.
The importance of avoiding mismatches (MM) at Class I and Class II HLA antigens in cyclosporine-treated renal allograft patients is controversial. In order to assess the role of HLA, 200 consecutive cadaveric renal allografts over a 4-year period were analysed. All patients received cyclosporine/predinisone immunosuppression and 75% were induced with ALG. Minimum follow-up period was one year. HLA A, B, DR, DQ, and DRw52/53 typing were available on 77-100% of allografts. A beneficial effect was noted at the HLA A locus. One-year survival was 87.2% in the 0 and 1 HLA A MM group combined vs 73.8% in the 2 HLA A MM group (p less than 0.05). The mean creatinine level at one year was also lower in the 0 plus 1 MM vs 2 MM group: 152.8 mumol/L vs 184.8 mumol/L, respectively (p less than 0.05). Significantly fewer rejection episodes occurred in the 0 and 1 HLA DQ MM group combined vs the 2 MM group. Steroid-resistant rejection episodes (SRRE) were not associated with the number of HLA MM. Patients who had an SRRE had significantly higher mean current and historical peak panel reactive antibodies (PRA) than patients who did not have SRRE. These results indicate that avoiding mismatches at the HLA A locus may improve renal allograft survival, and matching at HLA DQ may predispose patients to a more quiescent post-transplant course. The degree of preoperative sensitization may be an important etiologic factor in SRRE.
在接受环孢素治疗的肾移植患者中，避免I类和II类人类白细胞抗原（HLA）错配（MM）的重要性存在争议。为了评估HLA的作用，我们分析了4年期间连续的200例尸体肾移植。所有患者均接受环孢素/泼尼松免疫抑制治疗，75%的患者使用抗淋巴细胞球蛋白（ALG）进行诱导。最短随访期为1年。77%-100%的移植肾可进行HLA A、B、DR、DQ和DRw52/53分型。在HLA A位点观察到有益作用。0个和1个HLA A错配组的联合1年生存率为87.2%，而2个HLA A错配组为73.8%（p<0.05）。0加1个错配组1年时的平均肌酐水平也低于2个错配组：分别为152.8μmol/L和184.8μmol/L（p<0.05）。0个和1个HLA DQ错配组联合出现的排斥反应明显少于2个错配组。激素抵抗性排斥反应（SRRE）与HLA错配数量无关。发生SRRE的患者当前和既往的平均群体反应性抗体（PRA）峰值显著高于未发生SRRE的患者。这些结果表明，避免HLA A位点错配可能提高肾移植存活率，而HLA DQ匹配可能使患者移植后病程更平稳。术前致敏程度可能是SRRE的一个重要病因。
