建立器官移植配對實驗流程以鑑別自體抗體干擾：案例報告

Establishing an Experimental Procedure for Pre-transplantation Matching for a Patient with Autoantibodies: a Case Report

臨床需進行器官移植的患者，若患者體內存有抗捐者人類白血球抗原的抗體，術後常會發生急性 的排斥，而在器官移植配對檢驗中，補體依賴性毒殺實驗為最常用來檢測接受者體內是否已存在 抗捐者人類白血球抗原的抗體的方法。先前已有許多研究指出各項移植配對實驗各有其優缺點， 如何選擇合適的配對實驗方法常需要豐富的臨床經驗。在此案例中，一位四十一歲的男性患者， 患有第二型糖尿病並伴隨末期腎臟病，經評估需接受胰臟以及腎臟移植，先後與五位捐者進行補 體依賴性毒殺實驗結果顯示均為陽性，因此實驗室建立了一個簡易的篩檢流程，確認補體依賴性 毒殺實驗的陽性結果，為接受者體內的自體抗體免疫球蛋白M所造成，最後患者接受了胰臟移植手 術，追蹤一年後無出現任何免疫排斥反應。

In clinical transplantation, donor specific antibodies (DSA) are associated with hyperacute and acute humoral rejection. Complement dependent cytotoxicity (CDC) test is the most common assay used to detect DSA and reveal the compatibility between potential donor and recipient. Previous studies showed advantages and disadvantages of the various experiments frequently used before transplantation. Basically, the medical personnel required extensive experiences to choose a feasible examination for donor-recipient matching. We encountered a 41-year-old man with type II diabetes mellitus and end stage renal disease who was a candidate for pancreas before kidney (PBK) transplantation. In the initial work-up he was found reactive by CDC test with 5 cadavers’ cells. In this report, we set up an experimental procedure to demonstrate that the positive CDC test was due to the patients’ IgM autoantibodies. One year after pancreas transplantation, the patient tolerated the graft well without showing rejection or other immune responses.