【摘要】：目的:分析供者特異性抗體(DSA)在肝臟移植受者中的發(fā)生率及相關(guān)危險因素,及供者特異性抗體對肝移植受者術(shù)后移植物功能的影響,并探討其治療方法。方法:應(yīng)用Luminex液相芯片分析平臺及LABSScreen R軟件對2013年9月至2015年7月收集的139例肝臟移植病例進(jìn)行HLA(人類白細(xì)胞抗原)、群體反應(yīng)性抗體(PRA),對于PRA陽性病例,繼續(xù)行DSA、補(bǔ)體C1q、補(bǔ)體C4d及肝臟病理。結(jié)果:139例肝臟移植受者中,4例受者術(shù)后早期死亡(死亡時間分別為24天、12天、3天、5天),其余受者中位隨訪周期為15.3月(1.1-29.5月),其中供者特異性抗體(DSA)陰性者127例,陽性者共12例,包括術(shù)前受者體內(nèi)預(yù)存DSA(Pre DSA)2例,移植術(shù)后新生DSA(dn DSA)10例(其中1例移植術(shù)前預(yù)存DSA陽性),術(shù)后新生DSA發(fā)生率為7.19%。移植術(shù)前預(yù)存DSA2例中,Ⅰ類DSA 1例,基因位點為HLA-A;Ⅱ類DSA1例,基因位點為HLA-DQ;移植術(shù)后新發(fā)DSA10例,均是Ⅱ類DSA,基因位點均為HLA-DQ。DSA陽性病例中,5例肝臟病理提示肝纖維化、早期急性排斥和膽汁淤積。6例DSA陽性進(jìn)行C1q檢測,其中5例C1q檢測提示陽性。FK506(他克莫司)聯(lián)合甲強(qiáng)龍激素免疫治療為主的免疫抑制基礎(chǔ)上,嗎替麥考酚酯的應(yīng)用降低DSA的形成風(fēng)險(P=0.017),兒童移植病例中,嗎替麥考酚酯(MMF)的應(yīng)用減少DSA的形成(P=0.025)。91.7%(11/12)DSA陽性受者發(fā)生在HLA-DQ基因位點。肝移植術(shù)中巴利昔單抗的免疫誘導(dǎo)對DSA的形成無明顯影響(P=0.110)。對于DSA陽性病例的治療選擇包括移植術(shù)后調(diào)整FK506劑量,使移植術(shù)后6月內(nèi)FK506血藥濃度維持到目標(biāo)濃度;DSA陽性病例治療包括在FK506為免疫抑制劑基礎(chǔ)上,同時加用或增加嗎替麥考酚酯劑量,或給予甲強(qiáng)龍激素治療,丙種球蛋白免疫固化等治療選擇。結(jié)論:DSA是肝臟移植篩選致敏受者的重要指標(biāo),DSA對肝臟移植患者及移植物的預(yù)后生存情況存在嚴(yán)重影響,移植術(shù)后DSA需密切檢測,并根據(jù)檢查結(jié)果及時調(diào)整免疫抑制劑方案。
[Abstract]:Objective: to analyze the incidence and risk factors of donor-specific antibody (DSA) in liver transplant recipients and the effect of donor-specific antibody on graft function after liver transplantation. Methods: using Luminex liquid chip analysis platform and LABSScreen R software, 139 liver transplantation cases collected from September 2013 to July 2015 were treated with HLA (Human Leukocyte Antigen). The group reactive antibody (PRA), was used to continue DSA, for PRA positive cases. Complement C 1Q, complement C 4 d and liver pathology. Results: among 139 recipients of liver transplantation, 4 patients died early after operation (24 days, 12 days, 3 days, 5 days, respectively). The median follow-up period of the remaining recipients was 15.3 months (1.1-29.5 months). There were 127 cases of donor specific antibody (DSA) negative and 12 cases of positive, including 2 cases of preexisting DSA (Pre DSA) in recipients and 10 cases of DSA (dn DSA) after transplantation (including 1 case of positive pre-existing DSA before transplantation). The incidence of postoperative DSA was 7.19%. Of the patients with pre-transplantation DSA2, 1 case had class 鈪，

本文編號：2333287