HLA-DR匹配输血：供体特异性T细胞和B细胞抗体的产生及肾移植结局

Christiaans M H, van Hooff J P, Nieman F, van den Berg-Loonen E M

Department of Internal Medicine, University Hospital Maastricht, The Netherlands.

Transplantation. 1999 Apr 15;67(7):1029-35. doi: 10.1097/00007890-199904150-00016.

BACKGROUND

Pretransplant blood transfusions are reported to decrease acute rejection rate and increase graft survival after renal transplantation. This has been attributed to matching for HLA-DR with the transfusion donor, which also results in a lower rate of sensitization.

METHODS

The development of donor-specific T- and B-cell antibodies was measured by National Institutes of Health and two-color fluorescence assays after one transfusion in 247 naive patients. Auto-cross-matches were performed to exclude autoantibodies. Patients were grouped according to DR-matching (n=107) or nonmatching (n=140) with the transfusion donor. In 103 renal allograft recipients, acute rejection rate and graft survival were analyzed by Cox regression.

RESULTS

T-cell antibodies developed in 6.5% of the patients. There was no difference between the DR-matched and nonmatched group. No auto-antibodies against T-cells developed, whereas one quarter of the sera had a positive B-cell auto-cross-match. There was no difference with regard to B-cell antibodies (auto-antibody-positive sera excluded) between the DR-matched (15.8%) and nonmatched (18.6%) group. Sharing of HLA A and/or B antigens did not result in a lower frequency of donor-directed T- or B-cell antibodies. None of the risk factors, including DR sharing with transfusion donor, contributed significantly towards graft survival (odds ratio for DR sharing: 1.02; 95% confidence interval: 0.45-2.32; P=0.97). DR sharing was no risk factor towards acute rejection either, in contrast to DR mismatch with kidney donor (odds ratio: 2.9), and use of cyclosporine versus tacrolimus (odds ratio: 4.4).

CONCLUSIONS

Development of donor-directed T-cell antibodies after one transfusion of leukocyte-poor blood is low and irrespective of HLA-DR match with transfusion donor. B-cell antibodies develop more frequently and independent of HLA-DR match. In 26% of the sera, B-cell auto-antibodies are detected. Rejection rate and graft survival are not significantly different between HLA-DR-matched and nonmatched transfusions.

背景

据报道，肾移植前输血可降低急性排斥反应率并提高移植肾存活率。这归因于与输血供体的HLA-DR配型，这也会导致较低的致敏率。

方法

采用美国国立卫生研究院的方法和双色荧光分析法，对247例初次输血的患者输血一次后供体特异性T细胞和B细胞抗体的产生情况进行检测。进行自身交叉配型以排除自身抗体。根据与输血供体的DR配型情况（n = 107）或不配型情况（n = 140）对患者进行分组。在103例肾移植受者中，采用Cox回归分析急性排斥反应率和移植肾存活率。

结果

6.5%的患者产生了T细胞抗体。DR配型组和不配型组之间无差异。未产生针对T细胞的自身抗体，而四分之一的血清B细胞自身交叉配型呈阳性。在排除自身抗体阳性血清后，DR配型组（15.8%）和不配型组（18.6%）之间的B细胞抗体无差异。HLA A和/或B抗原的共享并未导致供体特异性T细胞或B细胞抗体的频率降低。包括与输血供体DR共享在内的所有危险因素均未对移植肾存活率产生显著影响（DR共享的比值比：1.02；95%置信区间：0.45 - 2.32；P = 0.97）。与肾供体DR错配（比值比：2.9）以及使用环孢素与他克莫司（比值比：4.4）相反，DR共享也不是急性排斥反应的危险因素。