The clinical significance of dynamic monitoring of anti?HLA antibody in kidney recipients

Objective To study the relationship between the level of anti-HLA antibody in kidney recipients before and after operation and the acute rejection of the graft.Methods and Results Forty-six kidney recipients,34 males,12 females,20～63 years were involved.The ELISA?PRA method of California University(terasaki method) was used to determine the level of antibody preoperatively,1 week,two weeks and 1 month postoperatively,and its relation to acute rejection was studied.Before transplantation,13 cases were positive(28.3%) by PRA(PRA10%),33 other cases were negative(71.75%).Of all the positive,there were 6 cases in which PRA50%.They received the therapy of serum exchange and immunosuppresents before operation.In the group of positive PRA,6 cases of acute rejeciton occured postoperatively.Two of the grafts were removed after therapeutic failure of large dose of methylprednisolone(MP).In the group of negative PRA,6 cases of acute rejection occurred.Four of them were cured with large dose of MP,and 2 others were cured with MP and ATG.After transplantation,there were 17 cases of positive PRA(4 of them were negative before transplantation),in 9 cases of which acute rejections occured postoperatively.Three cases of rejections occured in postoperatively negative PRA group.The difference was significant(P0.05).Conclusion The preoperative level of PRA is very important to acute rejection occurance,and postoperative level of PRA affects acute rejection and its prognosis.