| Summary: | 碩士 === 國立成功大學 === 臨床醫學研究所 === 97 === Purpose
Kidney transplantation remains the most effective means of renal replacement therapy. Preformed HLA antibodies is believed to be produced by pretransplant pregnancy, blood transfusion and prior tissue or organ transplantation. The purpose of this study is to investigate the correlation between anti-HLA immunization and graft outcome.
Experimental Design
This retrospective study used the ELISA method, LAT-M screen and Luminex HLA class I and II specificity assay to examine: (a) the impact of pre-transplant HLA antibody on long term graft survival; (b) a comparison of Luminex and ELISA methods in detecting HLA antibodies. A total of 319 renal transplant recipients followed up at NCKUH were studied. Serum from 292 renal transplant patients followed up at NCKUH were tested by the ELISA method (LAT-M) and 102 patients were tested by Luminex. Sera from 88 patients were re-tested by both ELISA LAT-M and Luminex in order to compare the efficacy of those two methods.
Results
The tests showed that in ELISA group, 18% had HLA antibodies before transplantation. The presence of HLA antibodies is related to increasing risk of graft loss (χ2=6.009 ,p=0.014), especially presence of anti-HLA class I+ II antibodies (p=0.023). In Luminex group. There was a difference in functional graft survival between patients with and without HLA antibodies, but it was not statistically significant (p=0.238). For patients shown by Luminex to have pre-transplant class II DSA (N=13), functional graft survival is significantly different than for those Luminex showed negative for class II DSA (P=0.002). However, there is no significant different between patients Luminex showed to have class I DSA I and those with no class I DSAI antibody (p=0.755).
Conclusions
The incidence of HLA antibodies detected by single-antigen-beads can be enormous- 72 % using Luminex compared with 17% using ELISA. Our results indicate that the detection of DSA by Luminex is more accurate than by ELISA. Luminex detected pre-transplant class II DSA had significantly worse graft survival than those without class II DSA antibody.
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