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对31例尸体同种肾移植受者作了一般显微淋巴细胞毒性交叉配合(Cross matching后称交配)所不能测出的前瞻性研究,来测定移植前预致敏的重要性。用抗体依赖性细胞介导的细胞毒性测定(ADCC)来显示供者特异性体液预致敏(humoral presensitization)与早期移植排斥的高发生率有关。受者在移植前具有阳性ADCC者,其6个月移植存活率为20％,而ADCC为阴性的受者则为75％(P<0.01)。对随机HLA抗原组合具有高度预先敏感性的受者群中,用~(51)铬释放补体依赖性细胞毒性(~(51)Cr-CDC)测定供者特异性体液预致敏与加速排斥亦有密切关系(P<0.05)。对所有受者作了被排移植物的病理检查都显示抗体介导排斥性血管炎(antibodymediated rejection vasculitis)。结论是目前流行应用的方法未能测定的体液预致敏,对早期肾移植排斥起主要的作用,也是尸体肾移植存活率低的主要原因。本研究提议采用ADCC和~(51)Cr-CDC测定作为常规辅助交配试验,可能改善肾移植的存活率。
A prospective study of 31 cadaveric allograft recipients who were not detectable by general microscopic lymphocytotoxicity (cross mating) was performed to determine the importance of pre-sensitization prior to transplantation. Antibody-dependent cell-mediated cytotoxicity assays (ADCC) were used to show that donor-specific humoral presensitization is associated with a high incidence of early graft rejection. Recipients who had positive ADCC before transplantation had 20% survival at 6 months and 75% (P <0.01) at ADCC negative. Donor-specific humoral pre-sensitization and accelerated rejection were measured with ~ (51) Cr-releasing complement-dependent cytotoxicity (~ (51) Cr-CDC) in a cohort of highly pre- There is a close relationship (P <0.05). Pathologic examination of all recipients that had been drained showed that the antibody mediated antibody-mediated rejection of vasculitis. The conclusion is that the prevailing application of the method failed to determine the pre-sensitization of the body fluid, which plays a major role in the rejection of early renal transplantation and is also the main reason for the low survival rate of cadaveric kidney transplantation. This study suggests that the use of ADCC and ~ (51) Cr-CDC assays as routine adjuvant mating trials may improve renal transplant survival.