The Application Of Human Leukocyte Antigen And Cross-Reactive Antigen Group Matching In Clinical Renal Transplantation

[Objective] To investigate the application and significance of human leukocyte(HLA) and cross-reactive antigen group(CREGs) matching in clinical renal transplantation.[Methods] Recipient's panel reactive antibody (PRA) was detected by using micro-complement-lymphocytotoxicity test with lambda cell tray.Donor and recipient HLA class I typing was performed with special monoclonal tray and HLA class II gene typing with micro-sequence-specific-primers (Micro-ssp) .Of all the 312 recipients whose PRA were negative were divided into two groups.One group of 149 kidney transplantations,Class I CREGs matching criteria replaced conventional HLA-A.B matching with two more A,B mismatches(MM) according conventional HLA matching criteria.Another group included a total of 163 kidney transplantation with A,BO-2 MM by the same criteria.Two groups were compared each other in one year graft survival rate and incidence of acute rejection in one month after transplantation. On the other hand,thirty-two sensitized patients whose PRA were positive (PRA>10%) were observed in HLA CREGs matching and outcome of post-transplantation.[Result] There is not statistically significant between class I CREGsOMM and conventional AN BOMM in one year graft survival rate and incidence of acute rejection in one month after transplantation disregarding DR (p>0.05) .It is also same with CREGslMM,CREGs2MM and A,B1MM A,B2MM respectively.However,Class I CREGsOMM is superior to A,B2MM group in survival rate and incidence of acute rejection(p<0.05).And the possibility of 0,1 mismatching was greatly enhanced by the CREG matching in comparing with that of 0,1 mismatching by conventional matching.PRA positive rate in 32 recipients was from 17% to 80% with an average of 39.84%;Patient with 0,1,2 or 3 MM of HLA CREGs+DR were 8(25%),10(31.25%),12(37.5%)and2(6.25%)cases respectively according to the the rule of CREGs matching and no case had 4-6MM.However the cases of 0,1,2,3 and 4 MM were 2 (6.25%),3 (9.38%),10 (31.25%),9 (28.12%) and 8 (25%) respectively by the standard of conventional HLA antigen matching and only 5 cases had shared 0-lMM.Only 9 patients developed acute rejection and were reversed by OKTs treatment.Renal function returned normal in all patients.[Conclusion] In the situation of disagree about conventional HLA matching,donor selection criteria based on Class I CREGs matching seem to favor recipients.By CREGs matching criteria selecting donor and recipient,better survival and less acute rejection can be achieved after transplantation. Morever,using CREGs matching criteria would significantly increase the chance of recipients to receive well-matched kidney and provide more chance for waiting recipients.Good HLA matching plays an important role in reducing the incidence of acute rejection and improving graft survival in sensitized patients.