中国组织工程研究

中国组织工程研究 ›› 2011, Vol. 15 ›› Issue (31): 5785-5788.doi: 10.3969/j.issn.1673-8225.2011.31.020

• 肾移植 kidney transplantation • 上一篇    下一篇

供者特异性活化T细胞频度预测肾移植急性排斥反应

陈卫国，王庆堂，王  亮，杨  航，周  鹏，曹文峰，刘祥丹，李沙丹   

  1. 解放军成都军区总医院泌尿外科，四川省成都市   610083
  • 收稿日期:2011-01-04 修回日期:2011-03-20 出版日期:2011-07-30 发布日期:2011-07-30
  • 作者简介:陈卫国★，男，1967年生，湖南省长沙市人，汉族，199 2年解放军第一军医大学毕业，硕士，副主任医师，主要从事泌尿外科方面的研究。 chenweiguo2004@sina.com

Pre-transplant frequency of donor-specific, interferon-gamma-producing T lymphocytes as a tool for forecasting acute rejections following kidney transplantation

Chen Wei-guo, Wang Qing-tang, Wang Liang, Yang Hang, Zhou Peng, Cao Wen-feng, Liu Xiang-dan, Li Sha-dan   

  1. Department of Urology Surgery, General Hospital of Chengdu Military Area Command of Chinese PLA, Chengdu  610038, Sichuan Province, China
  • Received:2011-01-04 Revised:2011-03-20 Online:2011-07-30 Published:2011-07-30
  • About author:Chen Wei-guo★, Master, Associate chief physician, Department of Urology Surgery, General Hospital of Chengdu Military Area Command of Chinese PLA, Chengdu 610038, Sichuan Province, China chenweiguo2004@sina.com

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摘要：

背景：提高移植后排斥反应风险预报的准确性，可为移植后个体化使用免疫抑制剂提供参考。
目的：寻找一种能定量分析供受者间免疫反应强度的方法来预测急性排斥反应。
方法：对同种异体尸肾移植的患者115例采用前瞻性分析，用ELISPOT法检测移植前分泌γ-干扰素的供者特异性活化T细胞的频度，观察随访期内有无急性排斥及肺部感染，并观察HLA错配与急性排斥的关系。
结果与结论：115例群体反应性抗体阴性肾移植受者中有25例发生急性排斥反应，发生急性排斥反应患者的供者特异性活化T细胞频度高于未发生急性排斥反应者(P < 0.01)，而HLA-I、II及总的错配数比较，差异均无显著性意义(P > 0.05)。提示，通过移植前对产生γ-干扰素的供者特异性活化T细胞频度的检测，可预测急性排斥反应，对潜在供者进行选择。

关键词: 活化T细胞, 肾移植, 供者特异性, 急性排斥, 肺部感染

Abstract:

BACKGROUND: Increasing the accuracy of rejection risk forecast post-transplant can provide reference for individualized use of immunosuppressive agent post-transplant.
OBJECTIVE: To investigate an immunological assay for donor-specific alloreactivity to identify patients at risk for future acute rejection.
METHODS: The pre-transplant frequency of donor-specific, interferon-γ-producing T lymphocytes in 115 patients who received kidney allograft was tested prospectively by ELISPOT-assay. Acute rejection and pneumonitis were observed within the period of follow-up. The relationship between HLA mismatching and acute rejection was also observed. 
RESULTS AND CONCLUSION: 25 patients who experienced acute rejection had significantly higher frequency of primed donor-specific T cells prior to transplantation compared with 90 patients without acute rejection (78.75±32.81 vs. 14.85±14.66,  P < 0.01). The sensitivity and specificity of the test were 84.0% and 94.4%. No significant difference was observed in HLA mismatches between patients who experienced acute rejection and patients who were free from acute rejection (P > 0.05). The rate of pneumonitis was higher in patients who experienced acute rejection than those who did not experience (44.0% vs. 14.4%, P < 0.05). The pre-transplant frequency of donor-specific memory cells correlated with the post-transplant risk of developing acute rejection episodes, may allow improved pairing of recipients with donors, and could identify high risk recipients for prophylactic, aggressive immunosuppression.

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