Lenaers Jo I V, Christiaans Maarten H L, Voorter Christina E M, van Hooff Hans P, van den Berg-Loonen Ella M
Tissue Typing Laboratory, University Hospital Maastricht, the Netherlands.
Transplantation. 2006 Nov 15;82(9):1142-7. doi: 10.1097/01.tp.0000236032.28751.a0.
De novo development of anti-human leukocyte antigen (HLA) antibodies after transplantation is associated with increased rejection and decreased graft survival. In this study, the effect of posttransplant HLA antibodies on clinical outcome was evaluated in patients treated with tacrolimus by means of flow cytometric crossmatches (FCXm).
T- and B-cell FCXm were performed retrospectively on posttransplant sera of patients who received a graft between 1997 and 1999. Ninety-four kidney-only recipients were tested and all FCXm positive sera were investigated for the presence of HLA class I and II antibodies by Flow panel reactive antibodies.
From 94 patients with a negative pretransplant complement-dependent cytotoxicity crossmatch, seven (7%) showed a positive pretransplant FCXm. After transplantation the FCXm became positive in five patients (6%). The predictive value of a positive FCXm after transplantation, and the log-transformed relative change in fluorescence ratio between pretransplant and posttransplant serum, were not significant to rejection within six months, nor to graft survival censored for death.
The presence of HLA antibodies before rejection or graft failure could only be shown in a minority of patients; most antibodies were detected after graft failure, especially after transplantectomy. Monitoring through antibody testing after transplantation on the basis of our results has no added value with tacrolimus-based immunosuppression.
移植后抗人白细胞抗原（HLA）抗体的新发与排斥反应增加及移植物存活期缩短相关。在本研究中，通过流式细胞仪交叉配型（FCXm）评估了接受他克莫司治疗的患者移植后HLA抗体对临床结局的影响。
对1997年至1999年间接受移植物的患者移植后的血清进行回顾性T细胞和B细胞FCXm检测。对94例仅接受肾脏移植的受者进行了检测，并通过流式板反应性抗体检测所有FCXm阳性血清中是否存在HLAⅠ类和Ⅱ类抗体。
94例移植前补体依赖细胞毒性交叉配型阴性的患者中，7例（7%）移植前FCXm呈阳性。移植后，5例患者（6%）的FCXm转为阳性。移植后FCXm阳性的预测价值，以及移植前和移植后血清荧光比值的对数转换相对变化，对于6个月内的排斥反应或因死亡而截尾的移植物存活情况均无显著意义。
仅在少数患者中可发现排斥反应或移植物功能衰竭前存在HLA抗体；大多数抗体在移植物功能衰竭后检测到，尤其是在移植肾切除术后。根据我们的结果，在移植后通过抗体检测进行监测对于基于他克莫司的免疫抑制治疗并无额外价值。
