Laux Gunter, Opelz Gerhard
Department of Transplantation Immunology, Institute of Immunology, University of Heidelberg, Heidelberg, Germany.
Transplantation. 2004 Aug 15;78(3):442-6. doi: 10.1097/01.tp.0000128615.41964.bc.
On the basis of cross-reactive antibodies that react with different human leukocyte antigens (HLA) with shared epitopes, HLA-A and -B antigens can be assigned to cross-reactive groups (CREG). In the context of renal transplantation, it has been reported that matching for CREG results in improved graft outcome and reduces the requirement for rejection treatment. Because CREG matching also improves the equity of kidney distribution to ethnic minorities, a CREG-based cadaver kidney allocation policy was introduced in the United States a few years ago.
The authors reexamined the immunologic relevance of matching according to CREG using the data of the international Collaborative Transplant Study. A total of 91,917 patients who received a first cadaver kidney transplant between 1991 and 2002 formed the basis of this analysis.
The authors found that the underlying impact of matching for HLA antigens accounts entirely for the observed positive effect of CREG matching. For patients with a particular HLA antigen match grade, matching for CREG had no advantageous effect on graft outcome or rejection treatment. An immunologic basis for CREG matching could thus not be found in this large analysis of cadaver kidney transplants.
The findings indicate that CREG matching for kidney allocation is conceptually flawed from an immunologic viewpoint.
基于与具有共同表位的不同人类白细胞抗原（HLA）发生交叉反应的抗体，HLA - A和 - B抗原可被归入交叉反应组（CREG）。在肾移植背景下，有报道称CREG匹配可改善移植肾结局并减少排斥反应治疗需求。由于CREG匹配还能提高向少数族裔分配肾脏的公平性，几年前美国引入了基于CREG的尸体肾分配政策。
作者利用国际移植协作研究的数据，重新审视了根据CREG进行匹配的免疫学相关性。1991年至2002年间接受首次尸体肾移植的91917例患者构成了本分析的基础。
作者发现，HLA抗原匹配的潜在影响完全解释了观察到的CREG匹配的积极效果。对于具有特定HLA抗原匹配等级的患者，CREG匹配对移植肾结局或排斥反应治疗没有有利影响。因此，在这项对尸体肾移植的大型分析中未发现CREG匹配的免疫学基础。
研究结果表明，从免疫学角度来看，用于肾脏分配的CREG匹配在概念上存在缺陷。
