HLA配型对肾移植长期存活的影响
Effects of human leukocyte antigen compatibility on long-term survival after kidney transplantation
目的 分析HLA相容性与肾移植长期存活之间的关系,并探讨HLA-A、B、DR错配在肾移植中的影响.方法 回顾性分析2001年1月至2014年6月间1162例接受首次肾移植受者的临床资料.结果 肾移植术后1、5、10年受者存活率分别为95.4%、88.3%和74.3%,移植肾存活率分别为95.2%、81.3%和57.6%,受者与移植肾间生存曲线的差异有统计学意义(Log-rank检验X2=38.62,P<0.001).HLA抗原错配是影响受者和移植肾存活的危险因素(相对危险度=1.28/1.57,P<0.001).随着HLA错配数的增加,受者术后发生急性排斥反应的可能性越大(相关系数=1.13,P<0.001).此外,HLA-DR抗原错配是影响移植肾存活的独立危险因素(P<0.05).结论 供受者HLA相容性依然是影响肾移植效果的重要因素,尤其是HLA-DR抗原错配对移植肾长期存活的影响程度可能更为重要.
更多Objective To evaluate the effect of HLA compatibility on long-term survival after kidney transplantation,and explore the effect of HLA-A,B,DR compatibility on kidney transplantation.Method Data on 1162 patients undergoing first kidney transplantation performed between January 2001 and June 2014 were retrospectively analyzed.Result The 1-,5-,10-year patient/graft survival rate calculated by Kaplan-Meier was 95.4%,88.3%,and 74.3%,respectively.The 1-,5-,10-year death-censored graft survival rate was 95.2%,81.3%,and 57.6%,respectively.The log-rank test revealed that there was significant difference between the two survival curves (x2 =38.62,P<0.001).Cox multivariate analysis found that HLA mismatches were independent risk factors for reducing the patient or graft survival rate (=1.28/1.57,P<0.001).Logistic multivariate regression analysis confirmed the significant association between HLA mismatches and the risk of acute rejection (=1.13,P<0.001).In addition,HLA-DR mismatch was an independent risk factor for graft survival.Conclusion HLA compatibility between donor and patient continues to be a risk factor for graft survival.HLA-DR mismatch may get deeper influence on long-term kidney graft survival,particularly.
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