Ayna T K, Ciftci H S, Isitmangil G, Gurtekin M, Carin M
Medical Biology Department, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey.
Transplant Proc. 2011 Apr;43(3):805-8. doi: 10.1016/j.transproceed.2010.11.021.
Anti-donor antibodies, denoted as "panel-reactive antibodies" (PRAs), are one of the most important factors influencing graft survival after renal transplantation. PRA is generally analyzed with enzyme-linked immunosorbent assay or flow cytometry (FC), which identify the HLA antigen specific for the preformed antibody.
We tested 66 patients for FC crossmatch (FCXM) when they were called for cadaveric renal transplantation. Thirty of 66 patients were FCXM-positive; 36 were FCXM-negative. Among the FCXM positive crossmatches, 21 were T- and B-cell positive; seven B positive; and two T positive. The HLA antibodies in the sera of FCXM-positive patients were reanalyzed using flow-PRA.
We detected HLA antibodies in 28/66 sera with flow PRA. The sera of 16/21 T-/B-, FCXM-positive patients contained both class I and II anti-HLA antibodies, five had only class I anti-HLA antibodies. One out of seven B-cell FCXM-positive patients had class I and class II anti-HLA antibodies, three, class I and 1 class II anti-HLA antibodies; the other two were negative. Class I and class II HLA antibodies were observed in two T-cell FCXM-positive patients. Four of 36 patients who were FCXM-negative were flow PRA positive: one had both class I and class II HLA antibodies and three, only class I HLA antibody. The comparison of FCXM and flow PRA results was significant (P = .001).
FCXM results may be confirmed by flow PRA tests, an important method to differentiate HLA versus non-HLA antibodies.
抗供体抗体，即“群体反应性抗体”（PRA），是影响肾移植后移植物存活的最重要因素之一。PRA通常采用酶联免疫吸附测定法或流式细胞术（FC）进行分析，以识别预先形成抗体所针对的HLA抗原。
在66例患者被召集进行尸体肾移植时，我们对其进行了FC交叉配型（FCXM）检测。66例患者中30例FCXM阳性；36例FCXM阴性。在FCXM阳性交叉配型中，21例T细胞和B细胞均阳性；7例B细胞阳性；2例T细胞阳性。对FCXM阳性患者血清中的HLA抗体采用流式PRA重新进行分析。
我们采用流式PRA在66份血清中的28份中检测到了HLA抗体。21例T细胞/B细胞FCXM阳性患者的血清中同时含有I类和II类抗HLA抗体，5例仅含有I类抗HLA抗体。7例B细胞FCXM阳性患者中有1例同时含有I类和II类抗HLA抗体，3例含有I类抗HLA抗体，1例含有II类抗HLA抗体；另外2例为阴性。在2例T细胞FCXM阳性患者中观察到了I类和II类HLA抗体。36例FCXM阴性患者中有4例流式PRA阳性：1例同时含有I类和II类HLA抗体，3例仅含有I类HLA抗体。FCXM与流式PRA结果的比较具有显著性（P = 0.001）。
FCXM结果可用流式PRA检测进行确认，流式PRA检测是区分HLA抗体与非HLA抗体的重要方法。
