Abstract:

Objective To explore the influence of preoperative panel reactive antibody（PRA）levels on kidney transplantation rate and long-term outcome after transplantation. Methods Clinical data of 7 123 cases of uremia patients in the First Affiliated Hospital of Sun Yat-sen University were collected between January 1998 and June 2012. According to the preoperative PRA levels，the patients were divided into five groups. Group A 6 124cases，PRA negative. Group B 160 cases，PRA ＜10%. Group C 261 cases，PRA 10%-29%. Group D 374 cases， PRA 30%-80%. Group E 204 cases，PRA ＞80%. The kidney transplantation rate was compared among these five groups，and the human leukocyte antigen（HLA）mismatched，patients and grafts survival，estimated glomerularfiltration rate（eGFR）levels 1 year after transplantation，and incidences of complications after operation，such asdelayed graft function（DGF），acute rejection，chronic rejection and infection were also compared. Results Thekidney transplantation rate in group A was 31.9%. The kidney transplantation rate reduced significantly with theelevation of PRA levels，while in group E was 7.3%（P＜0.05）. The HLA mismatched loci decreased significantly with the elevation of PRA levels. The incidences of acute rejection and chronic rejection were significantly lower in group A and B compared to group E（all P＜0.05）. There were no differences in DGF and infection among the groups（all P＞0.05）. The long-term graft survival（1 year ：96.4% vs. 89.5%，5 years ：76.8% vs. 63.4%，10 years ：59.7% vs. 47.3%，all P＜0.05）and 1-year eGFR level（66.7 mL/min vs. 45.3 mL/min，P＜0.05）werebetter in group A compared to group E. However，there was no difference in patient's survival among the groups（all P＞0.05）. Conclusion With the elevation of preoperative PRA levels，the kidney transplantation rate decrease， the risk of acute rejection and chronic rejection increase，and the long-term outcomes of kidney grafts become worse.

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摘要：

目的 探讨术前群体反应性抗体（PRA）水平对等待肾移植患者接受肾移植的比例和术后长期疗效的影响。方法 收集中山大学附属第一医院 1998 年 1 月到 2012 年 6 月等待肾移植的 7 123 例尿毒 症患者资料，根据术前 PRA 水平的不同分为 5 组 ：A 组 6 124 例，PRA 阴性 ；B 组 160 例，PRA ＜10% ；C 组 261 例，PRA 10%～29% ；D 组 374 例，PRA 30%～80% ；E 组 204 例，PRA ＞80%。比较 5 组患者接 受肾移植的比例，5 组患者中接受肾移植者的术前人类白细胞抗原（HLA）错配情况，术后患者和移植肾存活率，术后 1 年估算肾小球滤过率（eGFR）情况，以及术后移植肾功能恢复延迟（DGF）、急性排斥、慢性 排斥和感染等并发症的发生率。结果 A 组患者接受肾移植的比例为 31.9%；随着 PRA 水平升高，患者接受 肾移植比例显著下降，E 组接受肾移植比例最低，为 7.3%（P＜0.05）。在接受肾移植的患者中，随着 PRA 水平升高，HLA 错配数显著降低。A 组和 B 组术后急性排斥和慢性排斥发生率均显著低于 E 组（均 P＜0.05）， 各组 DGF 和感染发生率差异无统计学意义（均 P＞0.05）。A 组的移植肾存活率优于 E 组（1 年 96.4% 比 89.5%，5 年 76.8% 比 63.4%，10 年 59.7% 比 47.3%， 均 P＜0.05）， 术 后 1 年 eGFR 水 平 也 优 于 E 组（66.7 mL/min 比 45.3 mL/min，P＜0.05），但各组患者存活率差异无统计学意义（均 P＞0.05）。结论 术前PRA 水平越高，肾移植接受率越低，术后发生急性排斥和慢性排斥的风险越高，移植肾的长期预后也越差。

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