Gîngu C, Moise Ana, Constantinescu Ileana, Serbănescu B, Surcel C, Sinescu I
Center of Uronephrology and Renal Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
Rom J Morphol Embryol. 2012;53(3):515-9.
The key of the successful renal transplantation is the ability to identify the best immunological match between donor and recipient considering the possibility of rejection phenomenon. The aim was to identify class I and/or class II cytotoxic antibodies in renal-transplanted patients in order to assess the immunological potential for prevention of subclinical or acute rejection episodes.
We have evaluated ninety-two patients who had kidney transplantation in 2010 in Fundeni Clinical Institute, Bucharest, Romania, concerning HLA matching and anti-HLA immunization status. For HLA genotyping were used molecular biology methods--PCR-SSP (Invitrogen, USA). For cytotoxic antibodies, the methods used were ELISA (GTI Diagnostics, USA) and Luminex (One Lambda, USA). Crossmatch tests between donor cells and recipient serum were performed by ELISA (GTI Diagnostics, USA). Rejection diagnosis was supported by renal biopsy.
In the 20 presensitized cases, the rate of acute rejection was 30% while in the 72 unsensitized cases the rejection was 19.4%. The incidence of acute rejection was higher in anti-HLA class I presensitized patients compared with anti-HLA class II (20% and 14.3%, respectively) but there was no significant difference compared to pre-transplant unsensitized patients (19.4%). Sequential post-transplantation monitoring of anti-HLA antibodies has shown in pre-transplant sensitized patients group a constantly increasing of PRA value, while in the pre-transplant unsensitized patients group, 32% developed de novo cytotoxic antibodies.
More sensitive and specific methods to detect anti-HLA antibodies before transplantation and sequential post-transplantation monitoring of these antibodies would be useful to identify patients who are at higher risk for allograft failure.
成功进行肾移植的关键在于，在考虑排斥反应可能性的情况下，能够确定供体和受体之间最佳的免疫匹配。目的是鉴定肾移植患者体内的I类和/或II类细胞毒性抗体，以评估预防亚临床或急性排斥反应发作的免疫潜力。
我们评估了2010年在罗马尼亚布加勒斯特Fundeni临床研究所接受肾移植的92例患者的HLA匹配情况和抗HLA免疫状态。采用分子生物学方法——PCR-SSP（美国Invitrogen公司）进行HLA基因分型。对于细胞毒性抗体，使用的方法是ELISA（美国GTI诊断公司）和Luminex（美国One Lambda公司）。通过ELISA（美国GTI诊断公司）进行供体细胞与受体血清之间的交叉配型试验。肾活检支持排斥反应的诊断。
在20例致敏病例中，急性排斥反应发生率为30%，而在72例未致敏病例中，排斥反应发生率为19.4%。与抗HLA II类致敏患者相比，抗HLA I类致敏患者的急性排斥反应发生率更高（分别为20%和14.3%），但与移植前未致敏患者相比（19.4%）无显著差异。移植后对抗HLA抗体的连续监测显示，在移植前致敏患者组中，PRA值持续升高，而在移植前未致敏患者组中，32%出现了新发细胞毒性抗体。
移植前检测抗HLA抗体的更敏感、特异的方法以及移植后对这些抗体的连续监测，将有助于识别同种异体移植失败风险较高的患者。
