Ichikawa Y, Hashimoto M, Nojima M, Sata M, Fujimoto N, Kyo M, Ishibashi M, Ohshima S, Amemiya H, Fukunishi T
Department of Urology, Hyogo Prefectural Nishinomiya Hospital, Japan.
Transplantation. 1993 Dec;56(6):1368-71. doi: 10.1097/00007890-199312000-00017.
Serotyping and genotyping (polymerase chain reaction with sequence-specific oligonucleotide probes method) were conducted on 520 unrelated individuals to determine the linkage disequilibrium of HLA-B and HLA-DRB1. Analyses of 511 kidney transplants (300 related and 211 cadaver recipients) were carried out at 4 transplant centers using the linkage disequilibrium of HLA-B and HLA-DRB1 established previously. All transplant recipients received CsA immunosuppression and were transplanted from June 1983 to December 1991. There were 51 significant linkages formed between HLA-B and HLA-DRB1 alleles (P < 0.05). DRB1-compatible transplants experienced a comparable 5-year graft success rate of 94% as did the HLA-identical recipients with a 100% 5-year success rate. However DRB1-incompatible recipients displayed a significantly reduced 5-year graft survival rate of 73% (73% vs. 94% P < 0.01). The 5-year graft survival rate of HLA-DR-incompatible recipients of 71% was compatible to the 73% for HLA-DRB1-incompatible recipients. No variation of rejection rate for DRB1-compatible grafts was seen in any of the 4 transplant centers. The results also indicated that HLA-DRB1 compatibility was essential for optimal success rate, regardless of HLA class I mismatches. The overall conclusion was that matching for HLA-DR was important to achieve optimal kidney graft survival on the molecular level but not on the serotyping level.
对520名无亲缘关系的个体进行了血清分型和基因分型（序列特异性寡核苷酸探针聚合酶链反应法），以确定HLA - B和HLA - DRB1的连锁不平衡。4个移植中心对511例肾移植受者（300例亲属供肾受者和211例尸体供肾受者）进行了分析，采用先前确定的HLA - B和HLA - DRB1的连锁不平衡情况。所有移植受者均接受环孢素免疫抑制治疗，移植时间为1983年6月至1991年12月。HLA - B和HLA - DRB1等位基因之间形成了51个显著的连锁关系（P < 0.05）。与DRB1匹配的移植受者5年移植成功率为94%，与HLA完全相同的受者（5年成功率为100%）相当。然而，与DRB1不匹配的受者5年移植存活率显著降低，为73%（73%对94%，P < 0.01）。HLA - DR不匹配受者的5年移植存活率为71%，与HLA - DRB1不匹配受者的73%相当。在4个移植中心中的任何一个，均未观察到与DRB1匹配的移植物排斥率有差异。结果还表明，无论HLAⅠ类错配情况如何，HLA - DRB1匹配对于获得最佳成功率至关重要。总体结论是，在分子水平而非血清分型水平上，HLA - DR匹配对于实现最佳肾移植存活率很重要。
