探討PRA預測國人移植後排斥反應、移植器官存活率的相關性

Correlation of rejection and survival rate on organ post- transplantation in Taiwan by panel reactive antibody detection

湯惠斐(Hui-Fei Tang)

指導教授 ： 何元順

臺北醫學大學/醫學院/醫學檢驗生物技術學研究所/碩士(2007年)

https://doi.org/10.6831/TMU.2007.00024

摘要

人類白血球抗原（Human Leukocyte Antigen）HLA組織相容基因檢測及抗體篩選是移植手術前實驗室重要的工作。器官移植研究中證實，在移植後HLA抗體的發展是反覆而持續的，有許多報告已經建議 HLA 抗體的存在與移植後器官存活有密切關係。而且，在移植前群組反應性抗體 Panel Reactive Antibody（PRA）的存在；與手術後產生排斥的機率及發生移植失敗結果有相關。這項研究將檢測群組反應性抗體，調查於移植手術前及術後持續反應預測異體器官移植失敗之間的相互關係。材料和方法︰持續追蹤從2004年10月到2007年4月，所有的器官移植接受者。於術前及術後每隔一個月連續收集血清冷凍保存。所有血清使用ELISA固相免疫分析法檢測 PRA，使用chi square 或Fisher exact test精確的比較差別變項。當 P值<0.05表示具統計顯著差異。結果︰44位移植病患中有27位男性和17個女性，43.6 (19-66歲)的平均的年齡。所有患者一年存活率81.1%。手術前PRA陽性檢測率(16.2%)，失敗率為57.1% (4/7)，相對於術前PRA陰性患者術後失敗率13.3% (4/30)。統計p=0.024(p<0.05)。移植手術後PRA陽性共6位，失敗率為83.3% (5/6)，手術後PRA陰性患者器官失敗率為9.7% (3/31)，統計其p=0.0007(p<0.05) 討論：實驗結果顯示器官（心臟、腎臟）異體移植之失敗與PRA的存在之間有重要的相互關係(p<0.05)。各移植中心於移植手術前篩檢PRA陽性病患，移植後定期監測PRA反應及生化指標性檢查之變化，可以早期預測移植後排斥反應，是監控穩定的器官移植演化的一種有用的方法。因受限於時間有限及個案數量太少涉及長期的器官異體移植失敗很多免疫學和非免疫學元素，及各種免疫抑制之使用，都可能導致排除PRA反應預測移植失敗的協定，需要更多移植個案和更長時間的後續行動證明。

關鍵字

人類淋巴球組織抗原 ； 排斥 ； 存活率 ； 群組抗體反應

並列摘要

The development of antibodies to human leukocyte antigens (HLA) after transplantation verified ongoing reactivity against the transplant, the presence of HLA antibodies correlates with poor graft survival. The presence of HLA antibodies prior to transplantation has been linked to worse post-transplant outcomes in many solid organ transplants. This study was to investigate the relationship between organ allograft failure and pre-transplantation panel reactive antibody (PRA) reactivity. METHODS: From October 2004 to Aril 2007, a total of 44subjects were enrolled. There were 27 males and 17 females, with a mean age of 43.6 years (range 19 -66). Organ allograft recipients were enrolled. PRA was determined in batch using a commercially available kit. Categorical variables were compared using chi square or Fisher exact test as appropriate. A p value less than 0.05 was considered statistically significant. RESULTS: Of all, one-year graft survival rate was 81.1%, and 7 (16.2%) had positive PRA tests before transplantation. One-year graft failure rate was 57.1% (4/7) for those with pre-transplantation PRA positivity and 13.3% (4/30) for those having pre-transplantation PRA negativity, p value was 0.024 (p<0.05). Graft failure rate was 83.3% (1/6) for those with post-transplantation PRA positivity and 9.7% (3/31) for those having post-transplantation PRA negativity, p value was 0.0007 (p<0.05). There was a significant correlation between renal allograft failure and the presence of PRA. CONCLUSIONS: PRA reactivity was significantly associated with one-year graft failure (p<0.05). Our results suggest that a routine post-transplant AHG-PRA test offers an early risk assessment of rejection episodes and may be a useful method for monitoring the solid organ transplant evolution. The limited case numbers and time of follow-up precludes confirming the association of pre-transplantation PRA and allograft failure. Furthermore, many immunologic and nonimmunologic factors, other than PRA, are involved in long-term kidney allograft failure. To enroll more case and longer follow-up are needed.

並列關鍵字

HLA ； Rejection ； survival ； PRA

參考文獻

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