Gloor James M, DeGoey Steven, Ploeger Nancy, Gebel Howard, Bray Robert, Moore S Breanndan, Dean Patrick G, Stegall Mark D
Department of Nephrology and Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Transplantation. 2004 Jul 27;78(2):221-7. doi: 10.1097/01.tp.0000128516.82593.47.
: Desensitization protocols have been developed to allow successful kidney transplantation in sensitized recipients. However, a detailed analysis of the impact of these protocols on alloantibody has not been performed.
: We studied 12 living-donor kidney-transplant recipients with positive antihuman globulin-enhanced complement dependent cytotoxicity (AHG-CDC) crossmatches against their donors. Using a variety of crossmatch techniques and single-antigen flowbeads (SAFBs), we characterized the specificity and amount of alloantibody at baseline before desensitization, after desensitization (using plasmapheresis followed by 100 mg/kg intravenous immunoglobulin, and anti-CD20 antibody), and 4 months after transplantation (after splenectomy and on maintenance immunosuppression).
: All 12 patients with a positive baseline AHG-CDC crossmatch were AHG-CDC crossmatch negative at the time of transplant (after desensitization). However, despite desensitization, the majority of patients had low-level donor-specific alloantibodies demonstrable on the day of transplantation by both flow crossmatch (FXM 8/12) and SAFBs (10/11). Four months after transplantation, no patient had a positive AHG-CDC crossmatch, but again the majority had persistent low levels of donor-specific alloantibodies by FXM (6/12) and SAFBs (9/11). No patient experienced hyperacute rejection, and the persistence of low levels of donor-specific alloantibodies did not correlate with the development of humoral rejection in the early posttransplant period.
: Despite desensitization, a majority of positive crossmatch transplant recipients demonstrate low levels of donor-specific alloantibodies both on the day of transplant and 4 months after transplantation. The impact of these antibodies appears to be minimal early after transplant, but their long-term significance bears further study.
已制定脱敏方案以实现致敏受者的成功肾移植。然而，尚未对这些方案对同种异体抗体的影响进行详细分析。
我们研究了12例活体供肾移植受者，其抗人球蛋白增强补体依赖细胞毒性（AHG-CDC）交叉配型与其供者呈阳性。使用多种交叉配型技术和单抗原流式微珠（SAFBs），我们在脱敏前的基线、脱敏后（使用血浆置换，随后静脉注射100mg/kg免疫球蛋白和抗CD20抗体）以及移植后4个月（脾切除术后并维持免疫抑制）对同种异体抗体的特异性和量进行了表征。
所有12例基线AHG-CDC交叉配型为阳性的患者在移植时（脱敏后）AHG-CDC交叉配型均为阴性。然而，尽管进行了脱敏，大多数患者在移植当天通过流式交叉配型（FXM 8/12）和SAFBs（10/11）均可检测到低水平的供者特异性同种异体抗体。移植后4个月，没有患者AHG-CDC交叉配型呈阳性，但大多数患者通过FXM（6/12）和SAFBs（9/11）再次出现持续性低水平的供者特异性同种异体抗体。没有患者发生超急性排斥反应，并且低水平供者特异性同种异体抗体的持续存在与移植后早期体液排斥反应的发生无关。
尽管进行了脱敏，大多数交叉配型阳性的移植受者在移植当天和移植后4个月均表现出低水平的供者特异性同种异体抗体。这些抗体在移植后早期的影响似乎最小，但其长期意义有待进一步研究。
