Lo A, Stratta R J, Alloway R R, Hodge E E
Department of Pharmacy, University of Tennessee-Memphis, Memphis, Tennessee, USA.
Transplant Proc. 2005 Mar;37(2):1289-90. doi: 10.1016/j.transproceed.2004.12.212.
The purpose of this study was to determine the influence of HLA matching on outcomes in simultaneous kidney-pancreas transplant (SKPT) recipients in a multicenter trial. From March 1999 to May 2001, a total of 297 SKPT recipients were enrolled in a prospective randomized trial of 2 daclizumab dosing strategies versus no antibody induction in combination with tacrolimus, mycophenolate mofetil, and steroids in SKPT recipients. Subanalyses using both univariate and multivariate models were performed at 1 year to identify factors associated with acute rejection, graft loss, or death. Potential risk factors evaluated were treatment group, African American ethnicity, HLA-A mismatches (MM), HLA-B MM, HLA-DR MM, total HLA MM, surgical technique, cytomegalovirus status of donor and recipient, and delayed graft function (DGF). Univariate analyses revealed that treatment group, HLA-A MM, HLA-B MM, total HLA MM >3, and DGF were significantly associated with acute rejection. These variables were then entered into logistic and Cox regression analyses. HLA-A MM and DGF were the only variables that remained significantly associated with acute rejection in the multivariate model. The relative risk for acute rejection in recipients with HLA-A MM was 1.56 (P = .02). In conclusion, despite contemporary immunosuppression, the degree of HLA MM, particularly HLA-A, and DGF are associated with an increased risk for acute rejection in SKPT recipients at 1 year. Less rejection was noted in patients with 0 MM at all 3 HLA loci and in patients with total HLA-MM <3. However, none of these factors affected short-term patient or graft survival rates.
本研究的目的是在一项多中心试验中确定HLA配型对同期肾胰联合移植（SKPT）受者预后的影响。1999年3月至2001年5月，共有297例SKPT受者参加了一项前瞻性随机试验，该试验比较了两种达利珠单抗给药策略与不进行抗体诱导联合他克莫司、霉酚酸酯和类固醇在SKPT受者中的应用。在1年时采用单变量和多变量模型进行亚组分析，以确定与急性排斥反应、移植物丢失或死亡相关的因素。评估的潜在危险因素包括治疗组、非裔美国人种族、HLA - A错配（MM）、HLA - B MM、HLA - DR MM、总HLA MM、手术技术、供体和受体的巨细胞病毒状态以及移植肾功能延迟（DGF）。单变量分析显示，治疗组、HLA - A MM、HLA - B MM、总HLA MM>3以及DGF与急性排斥反应显著相关。然后将这些变量纳入逻辑回归和Cox回归分析。在多变量模型中，HLA - A MM和DGF是仅有的与急性排斥反应仍显著相关的变量。HLA - A MM受者发生急性排斥反应的相对风险为1.56（P = .02）。总之，尽管有现代免疫抑制措施，但HLA MM的程度，尤其是HLA - A，以及DGF与SKPT受者1年时急性排斥反应风险增加相关。在所有3个HLA位点错配数为0的患者以及总HLA - MM<3的患者中，排斥反应较少。然而，这些因素均未影响短期患者或移植物存活率。
