Transplant Center/Glickman Kidney and Urological Institute, Department of Quantitative Health Sciences, and Allogen Laboratories, Cleveland Clinic, Cleveland, Ohio 44195, USA.
Urology. 2011 Aug;78(2):314-8. doi: 10.1016/j.urology.2011.02.068. Epub 2011 Jun 15.
To evaluate the effect of transplant nephrectomy (TN) on the percentage of panel reactive antibody (%PRA) and donor-specific antibody (DSA) levels in patients with renal allograft failure.
The records of patients with failed kidney transplants, who had undergone TN from 2000 to 2007, were reviewed. The pre- and post-TN serum samples were available for analysis from 31 patients. Human leukocyte antigen typing and the %PRA was measured in these patients using standard serologic techniques. The pre- and post-TN patient serum samples were evaluated for DSA levels using solid phase assays and single antigen beads. The pre- and post-TN measurements of the %PRA and DSA levels were compared using the Wilcoxon signed rank test, and the associated clinical variables were identified on multivariate regression analysis.
The mean %PRA increased from 33.4 to 75.6 for class I antigens (P < .001) and from 38.9 to 60.6 (P = .002) for class II antigens in patients before and after TN, respectively. This increase was associated with an increase in the mean human leukocyte antigen class I and class II DSA levels from 33,518 molecular equivalents of soluble fluorochrome (MESF) to 121,457 MESF (P < .001) and from 45,459 MESF to 126,968 MESF (P < .001), respectively. Regression analysis showed that rejection episodes and an interval from graft failure to TN of <10 months were associated with greater increases in the mean %PRA (P < .001) and mean DSA levels (P = .02).
The results of the present study have confirmed that the %PRA increases after TN in patients with renal allograft failure, and sensitization occurs after TN, with an increase in DSA levels. Rejection episodes and early TN after graft failure might result in a greater degree of sensitization.
评估移植肾切除术（TN）对移植肾功能衰竭患者群体反应性抗体（%PRA）和供体特异性抗体（DSA）水平的影响。
回顾了 2000 年至 2007 年间接受 TN 的移植肾功能衰竭患者的记录。31 例患者的 TN 术前和术后血清样本可用于分析。采用标准血清学技术对这些患者进行人类白细胞抗原分型和%PRA 检测。采用固相检测法和单抗原珠法评估 TN 前后患者血清样本的 DSA 水平。采用 Wilcoxon 符号秩检验比较 TN 前后%PRA 和 DSA 水平的测量值，并采用多元回归分析确定相关的临床变量。
TN 前后，患者的类 I 抗原的平均%PRA 从 33.4%增至 75.6%（P<0.001），类 II 抗原的平均%PRA 从 38.9%增至 60.6%（P=0.002）。这一增加与 HLA 类 I 和类 II DSA 水平的平均水平从 33518 分子等价可溶性荧光（MESF）增至 121457 MESF（P<0.001）和从 45459 MESF 增至 126968 MESF（P<0.001）相关。回归分析显示，排斥反应发作和从移植物衰竭到 TN 的间隔时间<10 个月与平均%PRA（P<0.001）和平均 DSA 水平（P=0.02）的更大增加相关。
本研究结果证实，移植肾功能衰竭患者在接受 TN 后，%PRA 增加，并且在 TN 后发生致敏，DSA 水平增加。移植肾功能衰竭后发生排斥反应发作和早期 TN 可能导致更大程度的致敏。
