A large, single center investigation of the immunogenetic factors affecting liver transplantation.
A large, single center investigation of the immunogenetic factors affecting liver transplantation.
复制标题
影响肝移植的免疫遗传因素的大型单中心研究。
作者：
T. Doran;A. Geczy;D. Painter;G. McCaughan;A. Sheil;C. Süsal;G. Opelz
背景
关于免疫遗传因素在肝移植中的相关性的报告常常是相互矛盾的或不确定的。因此，我们研究了一系列可能影响肝移植存活的因素。
方法
单个中心对 13 年来的 446 名患者进行了 HLA、流式细胞术、增强的细胞毒性交叉配型和免疫球蛋白 (Ig)A 水平对移植物存活以及急性和慢性排斥反应的影响进行了研究。
结果
HLA错配对移植物存活的影响显着(P<10(-2))，并且在患有自身免疫性疾病的受者中逆转(P<0.5x10(-2))，而HLA错配对急性排斥反应水平的影响对所有受者都是有害的。阳性细胞毒性交叉配型对3个月（P<10(-5)）和1年（P<10(-4)）移植物存活有显着影响，并且流式细胞术交叉配型对慢性排斥反应（P<10(-2)）和急性排斥反应（P<10(-2)）也有额外作用。 HLA-A1、B8、DRB1*0301的受者发生急性排斥反应的风险较高(P<0.5x10(-2))，而接受ABO相容性异种移植的受者发生慢性排斥反应的风险显着较高(P<10(-2))。最后，在肾移植中观察到的高血清IgA，特别是IgA抗Fab的有益作用在肝移植中并不明显，事实上相反可能是正确的，至少对于急性排斥反应（P<0.5x10(-2)）。
结论
通过将患有自身免疫性疾病的受者与其他患者分开，并将急性和慢性排斥反应作为结果参数，我们利用大型单中心研究的力量来描述肝移植中涉及的一些重要免疫遗传因素的重要性。
BACKGROUND
Reports on the relevance of immunogenetic factors in liver transplantation are often conflicting or inconclusive. We have, therefore, investigated a range of factors that may underlie liver graft survival.
METHODS
The influences of HLA, flow cytometric, and enhanced cytotoxic crossmatching and immunoglobulin (Ig)A levels on graft survival, and acute and chronic rejection were investigated for a single center involving 446 patients over 13 years.
RESULTS
The effect of HLA mismatching on graft survival was significant (P<10(-2)) and was reversed in recipients with autoimmune diseases (P<0.5x10(-2)), whereas the effect of HLA mismatches on the level of acute rejection was detrimental in all recipients. There was a significant effect of a positive cytotoxic crossmatch on 3-month (P<10(-5)) and 1-year (P<10(-4)) graft survival, and an additional effect of the flow cytometric crossmatch was seen for chronic rejection (P<10(-2)) and acute rejection (P<10(-2)). Recipients with HLA-A1,B8,DRB1*0301 had higher levels of acute rejection (P<0.5x10(-2)), and recipients who received an ABO compatible-nonidentical transplant have a significantly higher risk (P<10(-2)) of developing chronic rejection. Finally, the beneficial effect of high serum IgA and, specifically, IgA anti Fab, seen in renal transplants was not evident in liver transplants, and in fact the opposite may be true, at least for acute rejection (P<0.5x10(-2)).
CONCLUSIONS
By separating the recipients with autoimmune disease from other patients and by including acute and chronic rejection as outcome parameters, we have used the power of a large single-centre study to delineate the significance of some of the important immunogenetic factors involved in liver transplantation.
针对 T 细胞阳性温交叉配的肝移植。
影响因子：
0.9
作者：
Iwatsuki,S;Rabin,BS;ShawJr,BW;Starzl,TE
通讯作者：
Starzl,TE