Practical Journal of Organ Transplantation(Electronic Version) ›› 2013, Vol. 1 ›› Issue (4): 235-239.

Previous Articles     Next Articles

The influence of preoperative panel reactive antibody levels on kidney transplantation rate and long-termoutcome aftertransplantation

CHEN Guo-dong1,SHI Lei2,QIU Jiang1,WANG Chang-xi1,FEI Ji-guang1,DENG Su-xiong1,LI Jun1,HUANGGang1,FU Qian1,CHEN Li-zhong1
  

  1. 1. Organ Transplant Center,the First Affiliated Hospital of Sun Yat-senUniversity,Guangzhou 510080,Guangdong,China ; 2. Zhongshan Medical School,Sun Yat-sen University,Guangzhou 510080,Guangdong,China
  • Online:2013-07-20 Published:2021-04-27

术前群体反应性抗体水平对肾移植接受率和术后长期疗效的影响

陈国栋 1 ,史磊 2 ,邱江 1 ,王长希 1 ,费继光 1 ,邓素雄 1 ,李军 1 ,黄刚 1 ,傅茜 1 ,陈立中 1
  

  1. 1. 中山大学附属第一医院器官移植中心,广东 广州 510080 ;  2. 中山大学中山医学院临床医学系 2009 级,广东 广州 510080
  • 基金资助:
    中山大学临床医学研究 5010 计划(2007003)

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.

Key words:

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 6 124 例,PRA 阴性 B 160 例,PRA 10% ;C 261 例,PRA 10%29% ;D 374 例,PRA 30%80% ;E 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%(P0.05)。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 P0.05), 各组 DGF 和感染发生率差异无统计学意义(均 P0.05)。A 组的移植肾存活率优于 E 组(1 年 96.4% 89.5%5 年 76.8% 63.4%10 年 59.7% 47.3% P0.05), 术 后 1 年 eGFR E (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。

关键词: