Kerman R H, Van Buren C T, Lewis R M, DeVera V, Baghdahsarian V, Gerolami K, Kahan B D
Department of Surgery, University of Texas Medical School, Houston 77030.
Transplantation. 1990 Jan;49(1):52-6. doi: 10.1097/00007890-199001000-00011.
We compared our standard NIH (extended incubation) crossmatch (XM) with antihuman globulin (AHG) and flow cytometry XMs and correlated the results with rejection episodes and graft survivals. For 89 CsA-Pred, primary renal allograft recipients, AHG and/or FCXM results did not improve on the NIH-XM-negative (NEG) graft survival results, whether testing pretransplant or historical (Hx) sera. Similarly, there was no association of a positive (POS) AHG or FCXM with increased rejection episodes in these primary recipients. However, for retransplant (Re-Tx) recipients a neg AHG or FCXM did discriminate fewer rejections and an improved graft survival compared with the NIH-XM-neg. results. The overall one-year graft survival for the 47 Re-Tx recipients studied herein was 66% (based on a neg pre-Tx NIH-XM). Pre-Tx AHG-NEG, Re-Tx recipients displayed an improved graft survival compared with NIH-XM NEG recipients (77% vs. 66%, P less than 0.05) and with AHG-POS recipients (77% vs. 47%, P less than 0.05). Similarly, pre-Tx, FCXM-NEG, Re-Tx recipients displayed improved graft survivals compared with NIH-XM-NEG recipients (83% vs. 66%, P less than 0.05) and FCXM-POS recipients (83% vs. 48%, P less than 0.05). Re-Tx recipients displaying a POS AHG and/or FCXM experienced a significantly greater number of rejections than NEG-XM recipients (P less than 0.05, respectively). The AHG and FCXM results correlated with rejections and graft survivals whether testing pre-Tx or Hx high-PRA sera. Re-Tx recipients who were AHG-XM-NEG but FCXM-POS, experienced more rejection episodes than recipients who displayed a negative XM reactivity for both AHG and FCXM (P less than 0.02), but with no resulting differences in graft survival. HLA matching, pre-Tx blood transfusions and PRA did not impact on these crossmatch and graft survival results. Use of AHG and/or FCXMs for Re-Tx, but not primary, recipients should help to improve graft survival for these high-risk recipients.
我们将我们的标准美国国立卫生研究院（延长孵育）抗人球蛋白（AHG）交叉配型（XM）与流式细胞术交叉配型进行了比较，并将结果与排斥反应发作和移植物存活情况相关联。对于89例接受环孢素A-泼尼松治疗的初次肾移植受者，无论检测移植前血清还是历史（Hx）血清，AHG和/或流式细胞术交叉配型结果均未改善美国国立卫生研究院交叉配型阴性（NEG）的移植物存活结果。同样，在这些初次受者中，AHG或流式细胞术交叉配型阳性（POS）与排斥反应发作增加并无关联。然而，对于再次移植（Re-Tx）受者，与美国国立卫生研究院交叉配型阴性结果相比，AHG或流式细胞术交叉配型阴性确实能区分较少的排斥反应且移植物存活情况有所改善。本文研究的47例再次移植受者的总体一年移植物存活率为66%（基于移植前美国国立卫生研究院交叉配型阴性）。移植前AHG阴性的再次移植受者与美国国立卫生研究院交叉配型阴性受者相比，移植物存活率有所提高（77%对66%，P小于0.05），与AHG阳性受者相比也有所提高（77%对47%，P小于0.05）。同样，移植前流式细胞术交叉配型阴性的再次移植受者与美国国立卫生研究院交叉配型阴性受者相比，移植物存活率有所提高（83%对66%，P小于0.05），与流式细胞术交叉配型阳性受者相比也有所提高（83%对48%，P小于0.05）。显示AHG和/或流式细胞术交叉配型阳性的再次移植受者经历的排斥反应次数明显多于交叉配型阴性受者（P分别小于0.05）。无论检测移植前还是Hx高群体反应性抗体（PRA）血清，AHG和流式细胞术交叉配型结果均与排斥反应和移植物存活情况相关。AHG交叉配型阴性但流式细胞术交叉配型阳性的再次移植受者比AHG和流式细胞术交叉配型反应均为阴性的受者经历更多的排斥反应发作（P小于0.02），但移植物存活无差异。人类白细胞抗原（HLA）配型、移植前输血和群体反应性抗体并未影响这些交叉配型和移植物存活结果。对再次移植受者而非初次受者使用AHG和/或流式细胞术交叉配型应有助于提高这些高风险受者的移植物存活率。
