肾移植供受体HLA错配与术后并发恶性肿瘤的关系

Relation between donor-recipient HLA mismatching and combined malignant tumor after renal transplantation

    摘要
  • 摘要:
      目的  研究肾移植供受体人类白细胞抗原(HLA)错配与术后并发恶性肿瘤的关系。
      方法  对1993年至2009年在首都医科大学附属北京友谊医院泌尿科行肾移植手术5年以上,且有完整的供受体HLA分型的1 021例患者的临床资料进行研究。1 021例肾移植术后患者中,非肿瘤患者928例,恶性肿瘤患者93例。收集供受者HLA-A、B和DR 3个位点共6个抗原的错配情况,分析供受体HLA错配数与肾移植术后发生恶性肿瘤的关系,以及不同性别肾移植患者的供受体HLA错配数与术后发生恶性肿瘤的关系。
      结果  1 021例患者中9.11%(93/1 021)发生恶性肿瘤。HLA错配0~1,2、3、4、5和6个抗原的患者恶性肿瘤发生率分别为14%、13%、14%、6%、3%和4%。HLA半相合以上(HLA错配0~3个)患者的恶性肿瘤发生率明显高于HLA半相合以下(HLA错配4~6个)患者(14%比5%,χ2=24.11,P<0.005)。恶性肿瘤患者中,HLA半相合以上的男性和女性患者分别为12例和54例;HLA半相合以下的男性和女性患者分别为12例和15例, HLA半相合以上患者中女性患者所占比例高于男性患者(χ2=5.60,P<0.025)。
      结论  HLA配错数越低的肾移植患者特别是女性患者,其恶性肿瘤发生率越高。

     

    Abstract:
      Objective  To study the relation between donor-recipient human leukocyte antigen (HLA) mismatching and combined malignant tumors after renal transplantation.
      Methods  Clinical data of 1 021 patients who received renal transplantation from 1993 to 2009 in Department of Urology of Beijing Friendship Hospital of Affiliated Capital University of Medical Sciences over 5 years and had complete HLA typing were analyzed. In the 1 021 patients after renal transplantation, 928 cases were non-tumor patients and 93 cases were malignant tumor patients. The mismatching data of 3 locus (HLA-A, B and DR) with a total of 6 antigens of the donors and recipients were collected. The relation between donor-recipient HLA mismatching number and postoperative combined malignant tumors was analyzed. And that between genders was also analyzed.
      Results  Malignant tumors occurred in 9.11%(93/1 021)of the patients. The malignant tumor incidences of patients with HLA mismatch of 0-1, 2, 3, 4, 5 and 6 antigens were 14%, 13%, 14%, 6%, 3% and 4% respectively. Patients with HLA over half-matched (0-3 antigens mismatch) had higher incidence of malignant tumors compared with that in patients with HLA less than half matched (4-6 antigens mismatch) (14% vs. 5%;χ2=24.11,P<0.005). In the malignant tumor patients of 0-3 antigens mismatch, 12 cases were males and 54 cases were females. In the patients of 4-6 antigens mismatch, 12 cases were males and 15 cases were females. The proportion of female patients of 0-3 antigens mismatch was higher than that of male patients(χ2=5.60,P<0.025).
      Conclusions  For the renal transplant patients, especially female patients, the lower the HLA mismatching number is, the higher the malignant tumor incidence is.

     

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