Clinical Study On Monitoring Anti-HLA Antibodies For The Sensitized Patients After Kidney Transplantation

The short-term effect of renal transplantation has been greatly improved, but the long-term outcome is not so satisfying. Graft rejection is still a major problem to affect the survival of thansplant renal. Graft rejection is usually considered to be mediated by T lymphocytes, but recent studies had shown that humoral immuniny played an important role. In the early stages of the development, people did not know the HLA (Human leukocyte antigen) and the role of anti-HLA antibodies. Until 1969, Patel and Terasak revealed that anti-HLA antibodies would attack the transplanted kidney, and ultimately result in the loss of renal function. The researchers further found that Predoperative donor-specific anti-HLA antibodies may lead to antibody-mediated acute humoral rejection. A recent multi-center study showed that the renal dysfunction incidence of the recipients with postoperative anti-HLA antibodies was significantly higher than those who had not postoperative anti-HLA antibodies.When the patient contact the human major histocompatibility antigen through the transplant, blood transfusion, Predgnancy, etc,he would be sensitized,then the anti-HLA antibodies would be produced and exist in the peripheral blood,these antibodies named PRA are closely linked to acute graft rejection, chronic rejection, delayed graft function, graft survival rates. According to PRA level, patients can be divided into non-sensitized (<10%), slightly sensitized (11%～50%), moderately sensitized (51%～80%) and highly sensitized (>80%). With the popularity and development of the renal transplantation. The increase in the number of the sensitized patients has become an important factor to affect the success of renal transplantation. The kidney transplantation of sensitized recipients is one of the challenges in the field of organ transplantation, The high incidence of hyperacute rejection seriously affect the success rate of transplantation and graft survival rate. Because of the more public epitope of HLA, it is difficult to find cross-match negative kidney. With the constant-depth study of transplantation immunology, wide use of the new immunosupPredssive agents and the improvement of matching technology, we have significantly improved the success rate of transplantation and graft survival rate. The detection of HLA antibodies before operation in transplant centers at home and abroad has become a routine, but dynamic monitoring of specific HLA antibodies after transplantation has not yet widely apPredciated. The production of specific HLA antibodies after transplantation can increase renal allograft acute or chronic rejection, reduce the short-term and long-term kidney transplant survival rate. Donor-specific antibodies can damage the transplanted kidney. So, it is great significance to monitore the level of anti-HLA antibodies and their antibodies specificity after kidney transplantation of the sensitized patients. This issue is to explore the relationship between the changes of anti-HLA antibody level and the graft s long-term survival, the impact of different immunosupPredssive drugs program on the anti-HLA antibodies level.Objective:To investigate the effect of the changes in the anti-HLA antibodies level on the graft's long-term survival, the relationship between different immunosupPredssive drugs program and the anti-HLA antibodies level, and evaluate the clinical meaning of dynamic monitoring anti-HLA antibodies for the sensitized patients after transplantation.Methods:All the recipients' anti-HLA antibodies were measured before and after transplantation using One Lambda antigen tray (LAT). According to the changes in anti-HLA antibodies level after transplantation, the patients were divided into four groups and their serum creatine were compared in 1,3,5 years after kidney transplantation. All the recipients were also divided into two groups in according to immunosupPredssive drugs program and compared the changes in anti-HLA antibodies level.Results:1) After operation, there were 33 patients(41.25%) in the group of anti-HLAⅠantibodies increased and anti-HLAⅡantibodies increased,9 patients(11.25%) in the group of anti-HLAⅠantibodies increased and anti-HLAⅡantibodies decreased,11 patients(13.75%) in the group of anti-HLAⅠantibodies decreased and anti-HLAⅡantibodies increased,27 patients (33.75%) in the group of anti-HLA I antibodies decreased and anti-HLAⅡantibodies decreased.2) The serum creatine of the patients in the group of anti-HLAⅡantibodies increased was significantly higher than that of patients in the group of anti-HLAⅡantibodies decreased (P<0.05). While, The serum creatine of the patients in the group of anti-HLAⅠantibodies increased was no significantly different in that of the group of anti-HLAⅠantibodies decreased.3) There were 44 patients in the FMP group, the level of anti-HLAⅠantibodies of 28 patients (63.6%) reduced after operation, the level of anti-HLAⅡantibodies of 25 patients(61.0%) reduced; There were 36 patients in the CMP group, the level of anti-HLAⅠantibodies of 10 patients(27.8%) reduced after operation, the level of anti-HLAⅡantibodies of 11 patients(30.6%) reduced.Conclusions:1). Dynamic monitoring anti-HLA antibodies, especially anti-HLAⅡantibodies, in sensitized recipients after transplantation may help to assess their immune sensitization, guide clinical treatment and improve the allograft survival period. 2). The use of FMP may be superior to CMP in reducing anti-HLA antibodies' level.