The Clinical Significance Of Dynamic Monitoring DSA And NDSA On Renal Allograft Prognosis

Objective: To research the influence and significance of DSA and NDSA on renal allograft prognosis by monitoring their variation from preoperative to postoperative and the detection of Genotyping and antibody of HLA on preoperative.Mothods: The eight patients with renal allografts were detected the HLA genotyping and anti-HLA antibodies (anti-HLA class I and anti-HLA class II) before transplantation as well as DSA and NDSA within six months after transplantation by Flow PRATM beads. Simultaneously, their serum creatinine levels were tested. Then the impact of anti-HLA antibodies on renal allograft function and rejection was assessed with clinical data.Results:â—‹1There are four patients had no anti-HLA antibody and four patients had anti-HLA antibody before transplantation. Two patients who had anti-HLA antibody could not detect the specialties HLA antibody ; another two patients had anti-HLA antibody and detect the specialties HLA antibody (DSA and NDSA) before transplantation.â—‹2 The four patients had no anti-HLA antibody before transplantation. Except one patient died nearly one month after transplantation for severe pulmonary infection and the else three patients whose no anti-HLA antibodies had well functional renal allograft.â—‹3 The antibody titre and types of one patient who had anti-HLA antibody but could not detect the specialties HLA antibody preoperative were obviously increased postoperative of six months. The anti-HLA antibody's rate was 22.86% and the specialties HLA antibody have been detected: DR11(DSA) DR12 DR7 DR8(NDSA). The anti-HLA antibody's rate increased to 97.14% and new NDSA(DR4) has been detected at postoperative of twelve months. The creatinine level of renal function increased from 140umol/L at postoperative of one month to 222umol/L at postoperative of six months and the chronic rejection was occurred in clinical. The creatinine level of renal function retains to 200umol/L and the chronic rejection don't occurred after the treatment of Methylprednisolone and rapamycin(RPM)+MMF+CsA.â—‹4The one patient had antibodies of A11 and A34 before transplantation,the value of A11 antibody always retains four minute and the value of A34 antibody increased from four minute to eight minute. the value of new NDSA such as A23 A80 A32 and so on have four minute or eight minute after transplantation of one month, but the titres of the antibody fall off after transplantation. The patient had well functional renal allograft and the chronic rejection was not occurred in clinical.â—‹5The other one patient was detected DR15DSA before transplantation and developed acute rejection and rupture of renal allograft one week after transplantation, therefore the nephrectomy was performed.Conclusions: The detection of the HLA genotyping and the specialties anti-HLA antibodies (anti-HLA class I and anti-HLA class II) between donor and recipient is one of the most important index which can judge the development of chronic rejection after transplantation.The detection of the specialties anti-HLA antibodies by Flow PRATM beads have the highly sensitivity and specificity.It is important to detect anti-HLA antibodies regular follow-up postoperative, to analyze the antibody of DSA and NDSA with HLA Genotyping, to take effective therapy for decreasing the occurrence and development of acute or chronic rejection and hypofunction on renal allograft at the recipients with DSA and NDSA.