目的
腎臟移植是目前對末期腎衰竭最好的一種治療方式。預存抗體預存抗體的產生可能是由於之前的懷孕、輸血、曾接受過組織或器官移植所致。而我們期望能藉由此研究了解腎臟移植的預後與移植前人類白血球抗原抗體之相關性。

實驗設計
這是一個回溯性研究,使用酵素結合免疫吸附法, 流式點陣儀系統偵測第一型人類白血球抗原抗體及第二型人類白血球抗原抗體來加以檢視(1)移植術前人類白血球抗原抗體與移植腎臟長期存活率(2)比較流式點陣儀系統與酵素結合免疫吸附法偵測結果的差異。研究族群為319位長期在成大醫院追蹤的腎臟移植患者。其中有292位患者的移植術前血清使用酵素結合免疫吸附法檢測, 而102位患者的移植術前血清使用流式點陣儀系統檢測。其中88位患者的血清使用酵素結合免疫吸附法及流式點陣儀系統兩種方式檢測用以比較其差別。
結果
使用酵素結合免疫吸附法檢測的這一組顯示有百分之十八病患術前血清呈現人類白血球抗原抗體陽性。而呈現人類白血球抗原抗體陽性與移植腎增加失敗風險有關 (χ2=6.009 ,p=0.014), 尤其是同時出現第一型及第二型人類白血球抗原抗體 (p=0.023)。於使用流式點陣儀系統檢測的這一組, 顯示人類白血球抗原抗體的存在影響移植腎的長期存活時間, 但並無達到統計學的差異(p=0.238)。使用流式點陣儀系統檢測出捐贈者組織抗原特異抗體第二型的患者共有13位,其移植腎功能存活率明顯比未檢測出捐贈者組織抗原特異抗體第二型的患者來得差(P=0.002)。然而,此種情形並不會發在捐贈者組織抗原特異抗體第二型(p=0.755)。
結論
使用單一抗原珠子檢驗人類白血球抗原抗體可大幅提升偵測率- 使用流式點陣儀檢測出百分之七十二相較於酵素結合免疫吸附法僅有百分之十七。本研究顯示使用流式點陣儀系統比使用酵素結合免疫吸附法更能正確檢測出術前捐贈者組織抗原特異抗體,而使用流式點陣儀系統檢測出術前捐贈者組織抗原特異抗體第二型的患者其移植腎的存活率明顯較差。

Purpose
Kidney transplantation remains the most effective means of renal replacement therapy. Preformed HLA antibodies is believed to be produced by pretransplant pregnancy, blood transfusion and prior tissue or organ transplantation. The purpose of this study is to investigate the correlation between anti-HLA immunization and graft outcome.
Experimental Design
This retrospective study used the ELISA method, LAT-M screen and Luminex HLA class I and II specificity assay to examine: (a) the impact of pre-transplant HLA antibody on long term graft survival; (b) a comparison of Luminex and ELISA methods in detecting HLA antibodies. A total of 319 renal transplant recipients followed up at NCKUH were studied. Serum from 292 renal transplant patients followed up at NCKUH were tested by the ELISA method (LAT-M) and 102 patients were tested by Luminex. Sera from 88 patients were re-tested by both ELISA LAT-M and Luminex in order to compare the efficacy of those two methods.
Results
The tests showed that in ELISA group, 18% had HLA antibodies before transplantation. The presence of HLA antibodies is related to increasing risk of graft loss (χ2=6.009 ,p=0.014), especially presence of anti-HLA class I+ II antibodies (p=0.023). In Luminex group. There was a difference in functional graft survival between patients with and without HLA antibodies, but it was not statistically significant (p=0.238). For patients shown by Luminex to have pre-transplant class II DSA (N=13), functional graft survival is significantly different than for those Luminex showed negative for class II DSA (P=0.002). However, there is no significant different between patients Luminex showed to have class I DSA I and those with no class I DSAI antibody (p=0.755).
Conclusions
The incidence of HLA antibodies detected by single-antigen-beads can be enormous- 72 % using Luminex compared with 17% using ELISA. Our results indicate that the detection of DSA by Luminex is more accurate than by ELISA. Luminex detected pre-transplant class II DSA had significantly worse graft survival than those without class II DSA antibody.

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