マイクロビーズを用いた腎移植患者におけるHLA抗体の同定

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  • Detection of HLA antibody in kidney transplant patients using microbead

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<p>It has become clear that HLA antibodies cause hyper acute and acute rejection of transplanted kidneys. Moreover, there are some reports that in patients whose transplant kidneys were rejected, HLA antibodies became positive before the transplant kidneys dysfunction, and therefore HLA antibodies participated in the chronic rejection. Using the conventional LCT method to identify the HLA antibody, a satisfactory result was not always provided in spite of complicated operation. However, because the FlowPRATM method using microbead was developed in recent years, we examined the presence and specificity of HLA antibodies using this newer method in a kidney transplant case in our hospital. The objects were 34 cases. We used the FlowPRA Screening Test and Single Antigen Test (One Lambda) for identification of HLA antibodies. 14 out of 34 cases were antibody positive, including 7 before transplant positive and 7 after transplant positive. 2 out of before transplant positive cases became graft loss at the early phase after transplant and donor specific antibody positive. The other 5 cases are functioning well, because the HLA antibodies are donor nonspecific. On the other hand, the kidney function of all cases that became positive after transplant was worse, and in 5 cases, have received the hemo-dialysis therapy again and the donor specific HLA antibodies were detected. The donor specific HLA antibody was suggested on the reason for the dysfunction of a transplant kidney, and it was thought that periodical HLA antibody examinations using the FlowPRA method before and after transplantation were important. The FlowPRA method can be performed more easily, precisely and specifically than the LCT method. Moreover, it is more reliable on a test method. The establishment of the rescue therapy after HLA antibody positive is expected, and MMF therapy is suggested to be effective.</p>

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