采用单抗原微珠抗体检测肾移植受者体内供者特异性抗体.pdfVIP

采用单抗原微珠抗体检测肾移植受者体内 供者特异性抗体 高霞 唐敏英 王庆华 尚乐乐 蔡锦全 杨顺良 郭君其 吴卫真 谭建明 [摘要]目的 总结应用单抗原微珠抗体检测肾移植受者体内供者特异性抗体(DSA)的经验， 并探讨阳性DSA的处理方法及对移植肾功能的影响。方法 应用流式细胞微珠法检测亲属肾移植 受者移植前后单抗原微珠抗体，并分析DSA与排斥反应、移植肾功能的关系。结果 30例患者，检 测样本173份，其中移植前47份，移植后126份。移植前1例出现DSA，移植后8例出现DSA，应用 硼替佐米及增加免疫抑制剂治疗。应用硼替佐米治疗者1例DSA免疫荧光强度下降至阴性水平，2 例下降超过50％。出现DSA时与未出现DSA时的估算肾小球滤过滤分别为(1.50±0.59) ml/s与 (1.23±0.38) ml/s，差异有统计学意义(P＜0.05)。结论 采用单抗原微珠抗体动态检测DSA的效 果好，DSA的出现影响了移植肾eGFR，应用硼替佐米治疗可使DSA免疫荧光滴度下降。 肾移植；供者特异性抗体 GAO XiaTANG Application of single antigen antibody test in living-relative renal transplantation Min-ying WANG Qing-hua SHANG Le-le CAI Jin-quanYANG Shun-liang GUO J un-qi, WU Wei-zhen , TAN Jian-ming. Military Center of Organ Transplantation, General Hospital of Fuzhou Military Command, Fuzhou 350025, China [Abstract] Objective To analyze the clinical application of donor specific antibodies (DSAs) detected by a single antigen Luminex virtual crossmatch, and to discuss the treatment of DSA and the impact of DSA on renal function. Methods Serum from living-relative renal recipients before and after transplantation was investigated using a Luminex single antigen assay. The relation between DSA and renal acute rejection as well as renal function was analyzed. Results A total of 30 patients and 173 serum samples were tested, including 47 serum samples before transplantation, and 126 after transplantation. DSA was positive in one patient before transplantation, and 8 patients after transplantation. Three of the patients positive for DSA were treated by Bortezomib, 3 by addition of MMF, 2 by addition of CNI, 1 by addition of Sirolimus. The MFI of DSA in one of the patients treated by Bortezomib was decreased to below 1000, while that in the other two decreased by more than 50 ％. The renal eGFR at the time with and without DSA was (1.50 ± 0. 59) and (1.23 ± 0. 38) ml/s respectively (P＜0.05)