Research on Immunosuppression Therapy in Living Donor Liver Transplantation Based on Functional Analysis of B lymphocytes

本研究利用活体供者外周血淋巴细胞（T-/B-FCXM）进行流式细胞术交叉配型，探讨抗供者抗体在活体肝移植中的临床意义。移植前T-FCXM阳性的病例占8.5%，其中40%在1个月内发生急性排斥反应（移植前T-FCXM阴性的病例占15%），对移植物预后没有影响。移植前T-FCXM阳性的急性排斥反应发生较早（8天vs. 17天），需要更多的类固醇。另一方面，移植后T-FCXM阳性的病例（20.7%）伴随或随后出现急性排斥反应。所有阳性T-FCXM均检测到IgM， 41.7%的阳性T-FCXM出现IgG。虽然抗供体抗体仅限于急性排斥反应，但在abo血型不相容的急性排斥反应中未检测到。急性排斥反应3个月后的T-FCXM阳性率明显低于早期急性排斥反应1个月内的T-FCXM阳性率。这些结果表明体液免疫参与临床肝移植术后早期急性排斥反应，提示肝移植术后不同时期急性排斥反应的背景和机制不同，尽管化学和组织学变化明显相似。T-FCXM阳性血清也显示来自不同HLA类型的第三方淋巴细胞阳性，提示存在HLA非特异性公共抗体。B- fcxm在本系统中没有明显的临床相关性，这可以证明是由于B细胞上的体质球蛋白的非特异性反应。

The study investigated clinical relevance of anti-donor antibody in living donor livertransplantation by flowcytometry crossmatch using peripheral blood lymphocytes (T-/B-FCXM) from living donors.Pretransplant T-FCXM was positive in 8.5% of cases, of which 40% experienced acute rejection within one month (vs. 15% with negative Pretransplant T-FCXM ; NS) without any influence on graft prognosis. Acute rejection with positive pretransplant T-FCXM occurred earlier (8 days vs. 17 days) and needed more steroids. On the other hand, cases with positive posttransplant T-FCXM (20.7%) experienced concomitant or following acute rejection. IgM was detected in all positive T-FCXM and IgG appeared in 41.7% with chronological class switching. Though anti-donor antibody was confined to acute rejection episodes, it was not detected in acute rejection in ABO-incompatible cases. Positive T-FCXM rate in acute rejection later than 3 months was much lower than that in early acute rejection within one month.These results demonstrated the involvement of humoral immunity in early acute rejection after clinical liver transplantation and suggest that background and mechanism of acute rejection vary in the different period after liver transplantation, despite apparently similar chemical and histological changes. Positive T-FCXM sera showed positivity also for lymphocytes from several third parties with diverse HLA types, suggesting the presence of HLA-nonspecific public antibodies.B-FCXM in the present system showed no significant clinical relevance, provably due to non-specific reaction by constitutional globulin on B cells.