腎臟移植是目前對末期腎衰竭最好的一種治療方式。在之前的研究中發現抗-HLA抗體與晚期發生移植體衰竭有關，而我們期望能藉由此研究瞭解腎臟移植的預後與移植後所產生的抗-第一型HLA CREGs抗體、抗-第二型HLA抗體之相關性。在十年長期門診追蹤分別收集40位慢性排斥CR與172位穩定功能SF的腎臟移植病人在移植前後不同時間點的血清；另外也取得作為正常控制組40位自願骨髓捐贈者與76位尿毒症的血清也納入此次研究作比較。利用酵素結合免疫吸附法（ELISA）－Lambda Antigen Tray system偵測抗-第一型HLA抗體與抗-第二型HLA抗體。在抗第一型HLA的抗體方面：93%慢性排斥CR的族群會發展出對抗第一型HLA的抗體，穩定功能SF的族群只有19%而已。進一步分析這些HLA 抗體，我們發現當中所有29位慢性排斥CR的族群（0%）都沒有會偵測到抗-捐贈者第一型HLA的抗體，當中4位（14%）有抗-捐贈者第一型HLA CREGs抗體；也都沒有會偵測到抗-受贈者第一型HLA的抗體，當中9位（31%）有對抗受贈者第一型HLA CREGs抗體；在抗第二型HLA的抗體方面：85%慢性排斥CR的族群會發展出對抗第二型HLA的抗體，穩定功能SF的族群只有20%而已。進一步分析這些HLA 抗體，我們發現當中所有29位慢性排斥CR的族群（0%）都沒有會偵測到抗-捐贈者第二型HLA的抗體；非常意外的，居然有6位（21%）有對抗受贈者第二型HLA的抗體。本研究認為移植後產生的抗-HLA抗體和慢性排斥反應有高度的相關性，其中以CREGs配對不容忽視，其會影響腎臟移植慢性排斥反應。另外我們觀察到的抗-受贈者第二型HLA的抗體想必在慢性排斥反應的機轉中應該是一重要因子。

　Kidney transplantation remains the most effective means of renal replacement therapy. HLA antibodies have been shown to be associated with late graft loss of organ transplants in prior studies. The relationship between humoral immune response and chronic rejection of renal transplants remains problematic. The purpose of this study was to investigate the correlation between graft outcome and post-transplant development of anti-human leukocyte antigen (HLA) cross-reactive groups (CREGs) -specific antibodies and anti-HLA class II-specific antibodies. Sera from 40 chronic rejection (CR) transplants and 172 stable function (SF) transplants were reviewed before renal transplantation and during a 10-year follow-up. Sera from 40 healthy volunteers served as controls and from 76 patients with uremia were included for comparison. Anti-HLA class I CREG and class II-specific antibodies were detected by the ELISA Lambda Antigen Tray system. 93% CR transplants exhibited anti-HLA class I-specific antibodies following transplantation, compared to 19% in SF transplants. When examining the HLA specificities of the antibody, we found that none of the 29 CR transplants had developed donor-specific antibodies, 4 of the 29 CR transplants (14%) had developed antibodies to donor class I CREGs, and 9 of the 29 CR transplants (31%) had developed antibodies to antigens within recipient CREGs. Posttransplant antibodies reactive to HLA class II-specific antigens were observed in 24 of the 29 CR transplants (83%). Anti-recipient HLA class II-specific antibodies was observed in 6 of the 29 CR transplants (21%) versus. None of the 29 CR transplants developed anti-donor HLA class II-specific antibodies. Our study suggests that because posttransplant anti-donor HLA class I CREG- specific antibodies, anti-HLA class II-specific antibodies, and anti-recipient HLA class II specific antibodies are significant in CR transplants, CREGs matching may have a role to play in renal transplants with chronic rejection. Anti-recipient HLA class II-specific antibodies induction also may be an important element in the pathogenesis of chronic rejection in renal allografts.

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