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目的探讨携带抗供者特异性Ⅱ类抗体肾移植受者的免疫风险,和肾移植术后的临床结果。方法采用流式细胞交叉配型术,回顾性的分析了12例B细胞交叉阳性、T细胞交叉配型阴性的肾移植受者,并分析抗体特异性。结果 58.3%的患者含DSAⅡ类抗体,41.7%不含DSA。DSAⅡ阳性组急性排斥反应发生率为57%,DSAⅡ阴性组排斥发生率为0(P<0.05)。小管周的毛细血管的C4D染色阳性率DSAⅡ阳性组为86%,DSAⅡ阴性组为40%(P<0.05)。DSAⅡ阳性组有1例患者术后3个月由于发生了加速性排斥反应丢失移植物,而其余DSAⅡ阳性的患者肾功维持3~37个月。结论 DSAⅡ阳性抗体的患者,肾移植术后发生体液排斥反应的机率高,建议术前进行脱敏处理和术后严密的免疫检测以防止急性排斥反应的发生。
OBJECTIVE: To investigate the immunological risks of renal transplantation recipients with anti-donor-specific class II antibodies and clinical outcomes after kidney transplantation. Methods Flow Cytometry was used to retrospectively analyze 12 cases of B cell cross positive and T cell crossmatch negative renal transplant recipients and to analyze the antibody specificity. Results 58.3% of patients with DSA Ⅱ antibody, 41.7% without DSA. The incidence of acute rejection in DSAⅡpositive group was 57%, and that in DSAⅡ negative group was 0 (P <0.05). The positive rate of C4D staining of capillaries in small tube was 86% in DSAⅡpositive group and 40% in DSAⅡ negative group (P <0.05). One patient in the DSA II positive group lost the graft at 3 months after surgery because of accelerated rejection. The remaining DSA II patients maintained renal function for 3 to 37 months. Conclusions Patients with DSA II-positive antibody may have a high chance of humoral rejection after renal transplantation. It is recommended that desensitization and postoperative strict immunosuppression be performed preoperatively to prevent acute rejection.