Bunnapradist S, Hong A, Lee B, Takemoto S K
Multiorgan Transplant Program, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
Transplant Proc. 2005 Mar;37(2):886-8. doi: 10.1016/j.transproceed.2004.12.084.
HLA mismatches have a strong impact on acute rejection and renal allograft survival. The objective of this study was to evaluate the effectiveness of antibody induction according to the degree of HLA mismatches.
Of 20,429 deceased donor (DD) transplantations and 12,859 living donor (LD) transplantations reported to the United Network for Organ Sharing (UNOS) between 1999 and 2001, 51% of DD and 45% of LD transplant recipients received induction therapy. Propensity scores (PS) were calculated to indicate independent factors associated with the use of induction. Levels of HLA match examined for DD transplant recipients were 0 ABDR (n = 3239), 0 DR (n = 4210), and DR mismatched transplants (n = 12,980), and 0 (n = 1133), 1 (n = 3836), and 2 (n = 7890) haplotype mismatches for LD transplant recipients. Outcome parameters were reported as hazard ratios (HR) for graft loss and odds ratios (OR) for first-year acute rejection.
Recipients with HLA mismatches were more likely to receive induction antibody for DR mismatch in DDs (PS = 1.11, 95% confidence interval [CI] 1.04-1.19) and for haplotype mismatch in LDs (PS = 1.36, 95% CI 1.22-1.52). Induction reduced the likelihood of acute rejection for DD transplant recipients regardless of the level of HLA mismatch (OR = 0.70; 95% CI 0.57-0.85 in 0 ABDR MM; OR = 0.76, 95% CI 0.64-0.89 in 0 DR MM; and OR = 0.69, 95% CI 0.62-0.77 in DR MM), and for 2 haplotype mismatched LD transplant recipients (OR = 0.82, 95% CI 0.70-0.96); in other LD transplant recipients, reductions in acute rejection rates were observed but not statistically significant. Induction reduced the risk of graft loss for DR mismatched DD transplant recipients by about 12% (HR = 0.88; 95% CI 0.80-0.97).
Antibody induction resulted in a significant reduction of acute rejection and graft loss for patients with HLA mismatch.
HLA错配对急性排斥反应和肾移植存活率有重大影响。本研究的目的是根据HLA错配程度评估抗体诱导的有效性。
在1999年至2001年向器官共享联合网络（UNOS）报告的20429例 deceased donor（DD）移植和12859例 living donor（LD）移植中，51%的DD移植受者和45%的LD移植受者接受了诱导治疗。计算倾向评分（PS）以表明与使用诱导相关的独立因素。对DD移植受者检查的HLA匹配水平为0 ABDR（n = 3239）、0 DR（n = 4210）和DR错配移植（n = 12980），对LD移植受者检查的单倍型错配水平为0（n = 1133）、1（n = 3836）和2（n = 7890）。结果参数报告为移植失败的风险比（HR）和第一年急性排斥反应的优势比（OR）。
HLA错配的受者在DD移植中因DR错配（PS = 1.11，95%置信区间[CI] 1.04 - 1.19）和LD移植中因单倍型错配（PS = 1.36，95% CI 1.22 - 1.52）更有可能接受诱导抗体。无论HLA错配水平如何，诱导均降低了DD移植受者急性排斥反应的可能性（0 ABDR错配中OR = 0.70；95% CI 0.57 - 0.85；0 DR错配中OR = 0.76，95% CI 0.64 - 0.89；DR错配中OR = 0.69，95% CI 0.62 - 0.77），以及2个单倍型错配的LD移植受者（OR = 0.82，95% CI 0.70 - 0.96）；在其他LD移植受者中，观察到急性排斥反应率有所降低，但无统计学意义。诱导使DR错配的DD移植受者的移植失败风险降低了约12%（HR = 0.88；95% CI 0.80 - 0.97）。
抗体诱导使HLA错配患者的急性排斥反应和移植失败显著降低。
