Süsal Caner, Pelzl Steffen, Döhler Bernd, Opelz Gerhard
Department of Transplantation Immunology, Institute of Immunology, University of Heidelberg, Heidelberg, Germany.
J Am Soc Nephrol. 2002 Jun;13(6):1650-6. doi: 10.1097/01.asn.0000014256.75920.5b.
The identification of high immunologic responders is desirable for the selection of appropriate immunosuppressive regimens. With the collaboration of 29 transplant centers in 15 countries, we investigated whether the pretransplant serum content of soluble CD30 (sCD30), a marker for the activation state of Th2-type cytokine producing T cells, is a useful predictor of kidney graft outcome. Pretransplant sera of 3899 cadaver kidney recipients were tested for serum sCD30 concentration using a commercially available enzyme-linked immunosorbent assay kit. Subsequent kidney graft survival was analyzed. The 5-yr graft survival rate in 901 recipients with a high pretransplant serum sCD30 (> or =100 U/ml) was 64 +/- 2%, significantly lower than the 75 +/- 1% rate in 2998 recipients with low sCD30 (<100 U/ml) (P < 0.0001). High sCD30 was associated primarily with graft loss and not with patient death. The sCD30 effect on graft survival was evident in first transplants as well as in retransplants, in presensitized patients with lymphocytotoxic antibodies as well as in nonsensitized patients, and in patients who received HLA well-matched kidneys as well as in patients who received poorly matched grafts. Recipients with a high pretransplant sCD30 needed significantly more rejection treatment after the first posttransplant year and continued to lose grafts at a higher rate during the 5-yr follow-up period, indicating that pretransplant sCD30 predicts not only the risk of acute rejection but also of chronic allograft nephropathy.
识别高免疫反应者对于选择合适的免疫抑制方案很有必要。在15个国家的29个移植中心的合作下，我们研究了可溶性CD30（sCD30）的移植前血清含量（一种产生Th2型细胞因子的T细胞激活状态的标志物）是否是肾移植结果的有用预测指标。使用市售的酶联免疫吸附测定试剂盒对3899名尸体肾受者的移植前血清进行sCD30浓度检测。随后分析肾移植的存活率。901名移植前血清sCD30含量高（≥100 U/ml）的受者的5年移植存活率为64±2%，显著低于2998名sCD30含量低（<100 U/ml）的受者的75±1%的存活率（P<0.0001）。高sCD30主要与移植肾丢失相关，而与患者死亡无关。sCD30对移植存活的影响在首次移植以及再次移植中、在有淋巴细胞毒性抗体的致敏患者以及未致敏患者中、在接受HLA配型良好的肾脏的患者以及接受配型较差的移植物的患者中均很明显。移植前sCD30含量高的受者在移植后第一年之后需要显著更多的抗排斥治疗，并且在5年随访期内继续以更高的速率失去移植肾，这表明移植前sCD30不仅可以预测急性排斥反应的风险，还可以预测慢性移植肾肾病的风险。
