Seigler H F, Gunnells J C, Robinson R R, Ward F E, Amos D B, Rowlands D T, Burkholder P M, Klein W J, Stickel D L
J Clin Invest. 1972 Dec;51(12):3200-15. doi: 10.1172/JCI107147.
16 patients underwent renal transplantation from a sibling donor who was prospectively determined to be ABO compatible and HL-A identical with the recipient. Unidirectional mixed leukocyte reactions were performed; in each instance, lymphocyte stimulation in either direction was not observed. The plasma creatinine 10-68 months after transplantation in these 16 patients ranged between 0.9 and 1.9 mg/100 ml. The creatinine clearance ranged from 48 to 113 ml/min, and the blood urea nitrogen (BUN) ranged between 12 and 35 mg/100 ml. Urine protein excretion varied from 0.11 to 1.86 g/day. Six patients exhibited no detectable clinical episodes of acute rejection; they were treated with azathioprine alone and each of them demonstrated normal or near normal renal histology when biopsy specimens were obtained more than 6 months after transplantation. Nine patients experienced acute rejection episodes that required the use of steroid therapy. The severity of these rejection episodes was variable; they included a mild reduction in renal function with an immediate steroid-induced restoration of function and eventual discontinuance of steroid therapy to severe reduction in function requiring prolonged and moderate doses of steroids without return to normal renal function. Renal histological observations in this group ranged from mild to marked cellular and structural changes which fit the criteria of the rejection. One patient demonstrated a gradual loss of renal function with heavy proteinuria. Biopsy of this allograft demonstrated the recurrence of original disease, i.e., lobular glomerulonephritis. The marked variability in the clinical course and allograft morphology in these 16 patients could be explained by antigenic differences at non-HL-A loci. The presence of minor histocompatibility loci has been well documented in other mammalian species and they are most certainly present in man. The need for their identification and definition is stressed.
16例患者接受了同胞供体的肾移植，该供体经前瞻性确定与受者ABO血型相容且HL - A相同。进行了单向混合淋巴细胞反应；在每种情况下，均未观察到双向淋巴细胞刺激。这16例患者移植后10 - 68个月的血浆肌酐在0.9至1.9mg/100ml之间。肌酐清除率为48至113ml/分钟，血尿素氮（BUN）在12至35mg/100ml之间。尿蛋白排泄量从0.11至1.86g/天不等。6例患者未出现可检测到的急性排斥临床发作；他们仅接受硫唑嘌呤治疗，并且在移植后6个月以上获取活检标本时，每例患者的肾脏组织学均显示正常或接近正常。9例患者经历了需要使用类固醇治疗的急性排斥发作。这些排斥发作的严重程度各不相同；包括肾功能轻度下降，类固醇治疗后功能立即恢复，最终停用类固醇治疗，以及严重的功能下降，需要长时间使用中等剂量的类固醇且肾功能未恢复正常。该组患者的肾脏组织学观察结果从轻度到明显的细胞和结构变化，符合排斥反应的标准。1例患者出现肾功能逐渐丧失并伴有大量蛋白尿。该移植肾活检显示原发病复发，即小叶性肾小球肾炎。这16例患者临床病程和移植肾形态的显著差异可由非HL - A位点的抗原差异来解释。次要组织相容性位点在其他哺乳动物物种中已有充分记录，在人类中肯定也存在。强调了识别和定义它们的必要性。
