Benefits of HLA-A and HLA-B matching on graft and patient outcome after cadaveric-donor renal transplantation.
Benefits of HLA-A and HLA-B matching on graft and patient outcome after cadaveric-donor renal transplantation.
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HLA-A 和 HLA-B 匹配对尸体供体肾移植后移植物和患者结果的益处。
DOI：
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发表时间：
1984
影响因子：
158.5
通讯作者：
W. Lefor
中科院分区：
文献类型：
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作者：
F. Sanfilippo;W. Vaughn;E. Spees;J. Light;W. Lefor
本文对东南器官采购基金会42个成员机构1977年6月至1982年7月进行的3811例肾移植的前瞻性资料进行了分析，以确定供受者的人类白细胞抗原A和B配型对患者和移植肾预后的影响。匹配良好的受者更有可能从自己的中心外接受肾脏，更高度预敏，包括更少的黑人，更有可能失去更早的移植。包括这些和其他6个潜在混杂变量的多变量COX回归分析显示，良好的人类白细胞抗原A和B配型与移植物存活率的增加之间存在显著的关联(P<0.001)。平均值(+/-S.E.)HLAA和B抗原配型最差和最匹配的受者的精算移植物存活率随着时间的推移而增加：6个月时为55+/-2%，而为+/-4%；4年时为18+/-4%，而4年时为44+/-7%。供受者HLA配型差是移植肾不可逆排斥反应的最大相对危险度(2.16)。在移植肾功能正常的患者中，匹配良好的受者血清肌酐水平较低，接受糖皮质激素的量明显较少。我们的发现表明，良好的HLA-A和B配型高度依赖于机构之间共享器官的系统，结果是减少了移植物排斥反应，改善了移植物的长期功能，减少了对移植后免疫抑制的需要。
Data collected prospectively on 3811 renal transplantations performed between June 1977 and July 1982 by the 42 member institutions of the South-Eastern Organ Procurement Foundation were analyzed to determine the influence of donor-recipient HLA-A and HLA-B matching on patient and graft outcome. Well-matched recipients were more likely to have received kidneys from outside their own centers, were more highly presensitized, included fewer blacks, and were more likely to have lost an earlier graft. Multivariate Cox regression analysis that included these and six other potential confounding variables revealed a significant association (P less than 0.001) between good HLA-A and B matching and increased graft survival. The difference in mean (+/- S.E.) actuarial graft survival between recipients worst matched and best matched for HLA-A and B antigens increased with time: 55 +/- 2 per cent as compared with 64 +/- 4 per cent at six months and 18 +/- 4 per cent as compared with 44 +/- 7 per cent at four years. Poor HLA matching of donor with recipient provided the greatest relative risk (2.16) of irreversible graft rejection of all the variables examined. Among patients with functioning grafts, well-matched recipients had lower serum creatinine levels and received significantly smaller amounts of glucocorticoids. Our findings indicate that good HLA-A and B matching is highly dependent on a system for sharing organs among institutions, and results in decreased graft rejection, better long-term graft function, and less need for post-transplantation immunosuppression.