肾移植中的人类白细胞抗原-A、B和DR抗原。关于西北大学和MEDUNSA经验的进一步报告。

HLA-A, B and DR antigens in renal transplantation. A further report on the Northwestern and MEDUNSA experience.

作者信息

Modiba M C, Ngcobo T K, Wolf J S, Morse R, Du Toit E D

机构信息

Department of Surgery, Medical University of Southern Africa, Pretoria.

出版信息

S Afr J Surg. 1994 Sep;32(3):99-102.

PMID:7597505

Abstract

HLA histocompatibility antigens form part of the basis of immune reactions in transplant immunology. However, controversy surrounds their use in renal allograft organ sharing. Selected HLA-related studies in the transplant programmes of Northwestern Memorial Hospital (NWMH), Chicago, USA, and the Medical University of Southern Africa (MEDUNSA), Pretoria, are presented. In the Northwestern Memorial Hospital experience with 27 recipients of O-mismatches, 48% were mixed leucocyte culture (MLC) compatible (% relative response < 25). Actuarial graft survival rates at yearly intervals up to 5 years were 100%, 100%, 85%, 75%, 75%, compared with 75%, 65%, 65%, 55% and 55% in compatible and incompatible groups, respectively (Breslow P = 0.05 and Mantel-Cox P = 0.11). Creatinine values at yearly intervals up to 5 years were significantly better in the MLC-compatible group (Mann-Whitney U-test P < 0.05). In the MEDUNSA experience with 85 black recipients of poorly HLA-matched renal allografts of the same donor race, actuarial graft survival at yearly intervals up to 5 years was 73%, 68%, 61%, 61% and 57%. The commonest HLA-A, B and DR antigens at MEDUNSA are A30, A9, A2, A10, A28; B17, B12, B42, B8; DR3, DR5 and DR4 (in this order of frequency). The NWMH experience illustrates that HLA-matching improves renal allograft survival in O-mismatches. At MEDUNSA, however, satisfactory results are obtained using kidneys harvested from black donors.

摘要

人类白细胞抗原（HLA）组织相容性抗原构成了移植免疫学中免疫反应基础的一部分。然而，它们在肾移植器官共享中的应用存在争议。本文介绍了美国芝加哥西北纪念医院（NWMH）和南非比勒陀利亚南非医学大学（MEDUNSA）移植项目中一些与HLA相关的研究。在西北纪念医院对27例O错配受者的研究中，48%的受者混合淋巴细胞培养（MLC）相容（相对反应率<25%）。在长达5年的时间里，每年的移植肾精算生存率分别为100%、100%、85%、75%、75%，而相容组和不相容组分别为75%、65%、65%、55%和55%（Breslow检验P = 0.05，Mantel-Cox检验P = 0.11）。在长达5年的时间里，每年的肌酐值在MLC相容组中明显更好（Mann-Whitney U检验P < 0.05）。在MEDUNSA对85例接受同一供者种族的HLA配型较差的肾移植的黑人受者的研究中，在长达5年的时间里，每年的移植肾精算生存率分别为73%、68%、61%、61%和57%。MEDUNSA最常见的HLA-A、B和DR抗原依次为A30、A9、A2、A10、A28；B17、B12、B42、B8；DR3、DR5和DR4。NWMH的研究表明，HLA配型可提高O错配肾移植的存活率。然而，在MEDUNSA，使用黑人供者的肾脏也取得了满意的结果。