Assessment of adult living related liver transplantation utilizing serum anti-liver arginase autoantibody assay : a possible novel strategy prospecting its prognosis.

背景/目的：亲体活体肝移植(LRLT)术后受者的临床免疫生化血液检测仍采用传统的联合检测血清肝标志物的方法。我们最近对肝病患者血清中抗肝脏精氨酸酶自身抗体的检测结果表明，在持续肝牵张时，自身抗体滴度保持在较高水平，但在肝损伤终止后，自身抗体滴度容易下降。这一现象促使我们寻求这种自身抗体是否可以作为LRLT术后受者的预后指标。基于这些发现，我们试图阐明即使在术后方案免疫抑制的情况下，血清AAA是否有合理的变化。方法：采用Western印迹和ELISA法检测和定量抗肝精氨酸酶自身抗体。结果：在术后住院时间较短(&lt；2个月)的病例中，AAA水平最终维持在5-26U之间的“临界区”，包括正常范围(19.7±6.0U)，而在预后差的病例中，长期住院(&gt；结论：AAA可作为反映肝牵张和免疫抑制的预后指标，这两个因素是LRLT的关键因素。考虑到这一点，AAA的使用可能会简化对受体的临床测试。

Background/Aims : Clinical immuno-biochemical blood test for postoperative recipients of living related liver transplantation (LRLT) is still done by combination of assaying serum liver markers as in the past. Our recent study, determining serum anti-liver arginase autoantibody in patients with liver disease, revealed that the autoantibody titre stayed high in continuous liver distraction but easily decreased after the termination of liver damage. This phenomenon prompted us to seek whether this autoantibody can be utilized as a prognostic marker for a postoperative recipient of LRLT.Based on these findings, we tried to clarify whether the serum AAA shows reasonable change even under the state of immunosupression due to postoperative regimen.Methods : Western blot and ELISA were undertaken for the detection and quantification of the anti-liver arginase autoantibody. In the ELISA system, rat liver arginase was used as a target antigen, taking advantage of its high immunological cross reactivity with human liver arginase and the ease of handling it provides.Results : In the cases with short postopcrative hospitalization (<2 months), AAA levels eventually stayed in "critical zone" settled between 5 and 26 U, including normal range (19.7 ± 6.0U), while in those with poor prognosis with prolonged hospitalization (>6months) or with recurrent short term discharge, AAA was never stayed in that level.Conclusions : AAA can be utilized as a prognostic maker that reflect both liver distraction and immunosupression, which are key factors in LRLT.With this in mind, utilization of AAA might ease clinical testing on recipients.