HLA 抗体对肝移植术后急性排斥发生的影响-中山大学附属第三医院器官移植研究所肝脏移植中心.docVIP

HLA抗体对肝移植术后急性排斥发生的影响 作者：陈伟1；陈规划2；陆敏强2；杨扬2；蔡常洁2；侯宝华2；林叶2；张伟东3；肖露露3　　(1广东省人民医院肝胆外科，广东 广州??510080；2中山大学附属第三医院器官移植研究所肝脏移植中心，广东 广州??510630；3广州器官移植配型中心，广东 广州??510095) 摘要：目的 探讨肝移植手术前后HLA抗体变化对移植肝脏急性排斥的影响。方法 134例患者接受改良背驮式肝移植，分别于手术前、手术后第1、7、14、30日通过酶联免疫吸附(ELISA)法检测HLA抗体，通过B超引导下肝穿刺病理检查明确有无急性排斥，观察肝移植前后HLA抗体变化对急性排斥发生的影响。结果 术前HLA抗体阳性组急性排斥发生率(56.8%)显著高于术前HLA抗体阴性组(25.9%) (P=0.001)；术前HLA抗体阴性而术后转为阳性组急性排斥发生率与术前术后HLA抗体均为阴性组有显著差异(P=0.003)。结论 患者术前HLA抗体阳性可能是引起肝移植术后急性排斥的原因之一，患者术后HLA抗体持续阳性与急性排斥的发生密切相关。 关键词：肝移植; HLA抗体; 急性排斥反应 中图分类号：R657. 3??文献标识码：A??文章编号： 1673-4254(2006)06-0774-03 Effects of the HLA antibodies on allograft acute rejection after cadaveric liver transplantationCHEN Wei1； CHEN Gui-hua2； LU Min-qiang2； YANG Yang2； CAI Chang-jie2； HOU Bao-hua1； LIN Ye1； ZHANG Wei-dong3； XIAO Lu-lu31Department of Hepatobiliary Surgery, People’s Hospital of Guangdong Province, Guangzhou 510080, China; 2Liver Transplantation Center, Institute of Organ Transplantation, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China; 3Guangzhou Tissue Typing Center,??Guangzhou??510095, ChinaAbstract: Objective To evaluate the effect of perioperative HLA antibody changes on acute allograft rejection in cadaveric liver transplantation. Methods Totally 134 patients received modified piggyback liver transplantation and enzyme-linked immunosorbent assay was performed for HLA antibody detection before and the 1, 7, 14 and 30 days after operation. B ultrasound-guided liver biopsy was employed for diagnosis of acute allograft rejection, and the perioperative changes of HLA antibodies were evaluated for their effect on allograft acute rejection. Results Of the 44 recipients with preoperative positivity for HLA antibodies, acute rejection occurred in 56.8% of the patients, as compared with 25.9% in those negative for HLA antibody (P=0.001). The patients who became positive for HLA antibody postoperatively had a rate of acute rejection of 60%, which was significantly higher than that in thos