Six-antigen-matched transplants. Causes of failure.
Six-antigen-matched transplants. Causes of failure.
复制标题
六抗原匹配移植。
DOI：
10.1097/00007890-199305000-00010
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发表时间：
1993
期刊：
影响因子：
6.2
通讯作者：
Terasaki,PI
中科院分区：
文献类型：
--
作者：
Takemoto,S;Cecka,JM;Gjertson,DW;Terasaki,PI
从1987年11月至1992年2月，通过UNOS6抗原配型计划对1386例身体肾移植的失败原因进行了研究。向联合国操作系统科学肾移植注册中心报告，1004例人类白细胞抗原相合的首次身体移植的一年移植物存活率为88%，而父母供者为90%，22,188例人类白细胞抗原不相合的首次身体供者为78%。在人类白细胞抗原不相合的身体肾功能衰竭中，55%的移植物丢失原因是免疫的，而在人类白细胞抗原相合的移植肾功能衰竭中，只有39%的移植物丢失是免疫的。年龄在17岁以下的人类白细胞抗原相合的首次移植受者的免疫失败率为57%，60岁以上的受者免疫失败率随着年龄的增长而下降到14%。在老年组中，因移植物功能正常而死亡的病例占失败病例的50%。致敏与配对的第一次移植受者的免疫失败发生率从非致敏患者的36%增加到广泛致敏患者的53%有关，第二次移植受者55%的免疫失败与第一次移植的39%相比。一些免疫学失败可能是由于组织分型，因为在具有明确的HLA抗原的肾脏中，只有18%的失败是免疫性的，而在与较难匹配的HLA抗原匹配的肾脏中，44%的肾脏由于免疫原因而丢失。结果表明，表型相同的身体肾移植降低了免疫失败率。随着这种组织分型对更难处理的人类白细胞抗原的准确性的提高，这组移植患者的免疫学失败率将进一步下降。
The causes of failure were studied for 1386 cadaver kidney transplants shared through the UNOS 6-antigen match program from November 1987 to February 1992. The one-year graft survival for 1004 HLA-matched first cadaver transplants was 88% compared with 90% for parent donor and 78% for 22, 188 HLA-mismatched first cadaveric donors reported to the UNOS Scientific Renal Transplant Registry. The cause of graft loss was immunological in 55% of HLA-mismatched cadaver kidney failures, whereas only 39% of the HLA-matched graft failures were immunological. The fraction of immunological failures in HLA-matched first transplant recipients younger than age 17 was 57% and decreased with increasing age to 14% for recipients older than age 60. Death with a functioning graft accounted for 50% of failures in the older age group. Sensitization was associated with an increased incidence of immunological failures in matched first graft recipients from 36% in nonsensitized to 53% in broadly sensitized patients, and 55% of failures were immunological in second graft recipients compared with 39% in first transplants. Some immunological failures may have been due to tissue typing, since only 18% of failures in kidneys with well-defined HLA antigens were immunological, whereas 44% of kidneys matched with more difficult HLA antigens were lost due to immunological causes. The results indicate that phenotypically identical cadaver renal transplants have a reduced rate of immunological failures. As the accuracy of this tissue typing for the more difficult HLA antigens improves, immunological failures in this group of transplants will decline even further.