Clinical study of HLA and cross reactive groups matching in sensitized recipients of kidney transplantation

Objective To investigate the effects of kidney transplantation in sensitized recipients receiving conventional human leukocyte antigen(HLA) and cross-reactive groups(CREG) matching.Methods The HLA and CREG matching were used to select the best donors for 82 recipients with high titer of panel reactive antibody(PRA),and adjunctive application of plasma exchange and intravenous immunoglublin were conducted.Results The successful rate was 90%(74/82) and mortality rate was 1%(1/82).The incidence of hyperacute rejection,accelerated acute rejection,acute rejection and delayed graft function was 4%(3/82),6%(5/82),28%(23/82) and 21%(17/82),respectively.The incidences of acute rejection in groups of broad sensitized,HLA class Ⅰantibody positive recipients,HLA antibody positive recipients of post-transplantation and donor specific antibody were higher than those in groups of mild sensitized,HLA classⅡantibody positive recipients,HLA antibody positive recipients of pre-transplantation non-donor and specific antibody respectively(all P0.01).According to the rule of HLA matching,the rates of patients with miss match(MM) sites numbers of 0 to 1,2 and 3 to 4 were 10%(8/82),24 %(20/82) and 66 %(54/82) respectively,and the rates were 46%(38/82),32%(26/82) and 22%(18/82) respectively according to the rule of CREG matching(P0.01).The application of plasma exchange and intravenous immunoglublin could reduce the level of panel reactive antibody,and prevent and treat the acute rejection in pre-and post-transplantation(P0.01).Conclusion Sensitization may be the most important cause of survival in kidney transplantation.Improved HLA and CREG matching can heighten the chance of success for renal transplantation in sensitized recipients.Plasma exchange and intravenous immunoglublin may play an important role in reducing acute rejection and enhancing the opportunity of allograft in sensitized recipients.