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

本研究以活体供者的外周血淋巴细胞(T-/B-FCXM)为材料，采用流式细胞术交叉配型的方法，研究了抗供体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%的患者在1个月内发生急性排斥反应(移植前T-FCXM阴性的占15%；NS)，对移植预后没有任何影响。移植前T-FCXM阳性的急性排斥反应发生得更早(8天比17天)，需要更多的类固醇。另一方面，移植后T-FCXM阳性的患者(20.7%)合并或继发急性排斥反应。所有T-FCXM阳性患者均检测到IgM，41.7%的T-FCXM患者出现免疫球蛋白G，并按时间顺序进行分类转换。虽然抗供体抗体仅限于急性排斥反应，但在ABO血型不合的急性排斥反应中未检测到。T-FCXM在3个月以后的急性排斥反应中的阳性率明显低于1个月内的早期急性排斥反应。这些结果表明体液免疫参与了临床肝移植术后早期的急性排斥反应，提示尽管肝移植后不同时期的化学和组织学改变相似，但发生急性排斥反应的背景和机制有所不同。T-FCXM阳性血清对不同HLA型的第三方淋巴细胞也呈阳性，提示存在非特异性公共抗体。本系统中的B-FCXM没有显著的临床相关性，这可能是由于构成球蛋白对B细胞的非特异性反应所致。

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.