Long-term follow-up in London Transplant Group recipients of cadaver renal allografts. The influence of HLA matching on transplant outcome.
Long-term follow-up in London Transplant Group recipients of cadaver renal allografts. The influence of HLA matching on transplant outcome.
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对伦敦移植小组尸体肾同种异体移植受者的长期随访。
DOI：
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发表时间：
1986
影响因子：
158.5
通讯作者：
J. Holmes
中科院分区：
文献类型：
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作者：
H. Festenstein;P. Doyle;J. Holmes
伦敦移植小组对 1341 名尸体肾移植患者进行了为期 6 个月至 14 年的随访，其中没有任何患者接受环孢素治疗，以确定 HLA I 类抗原（HLA-A、-B 和 -C）和 II 类抗原（HLA-DR、-MT 和 -DQ）对匹配供体和受体移植物存活的影响。通过匹配 HLA I 类抗原，尤其是 HLA-B，移植物的长期存活率大大提高。无法与两个 B 基因座抗原匹配但与 Bw4/Bw6 完全匹配的移植也表现良好。此外，自1978年以来，HLA-DR和-DRw52/53（HLA-MT）匹配已经获得了优异的结果，但HLA-DQ匹配却没有获得优异的结果。使用 Cox 回归模型的多变量分析证实，I 类和 II 类匹配的组合可显着提高移植物的存活率。因此，HLA-DR 加 HLA-B 匹配的移植以及 HLA-MT 加 HLA-B 匹配的移植均取得了优异的结果，甚至比报道的环孢素治疗的结果还要好。双重 HLA-MT 不相容性产生的结果最差。我们的结论是，这种结合 I 类和 II 类的广泛和狭义特异性的方法非常实用，并且组织类型的适当匹配在临床上很重要。
The London Transplant Group followed 1341 patients with cadaver renal transplants, none of whom received cyclosporine, for six months to 14 years to determine the effect on graft survival of matching donor and recipient for HLA Class I antigens (HLA-A, -B, and -C) and Class II antigens (HLA-DR, -MT, and -DQ). Long-term graft survival was greatly improved by matching for HLA Class I antigens, especially HLA-B. Transplants that could not be matched for both B-locus antigens but were completely matched for Bw4/Bw6 also did very well. In addition, since 1978, excellent results have been obtained with HLA-DR and -DRw52/53 (HLA-MT) matching, but not with HLA-DQ matching. Multivariate analysis using the Cox regression model confirmed that combination Class I and Class II matching produced significant improvements in graft survival. Thus, transplants matched for HLA-DR plus HLA-B and those matched for HLA-MT plus HLA-B had excellent results--even better than those reported with cyclosporine treatment. Double HLA-MT incompatibilities yielded the poorest results. We conclude that this approach of combining the broad and narrow specificities of Class I and II is extremely practical and that appropriate matching of tissue types is clinically important.