Higgins Rob, Hathaway Mark, Lowe David, Lam For, Kashi Habib, Tan Lam Chin, Imray Chris, Fletcher Simon, Zehnder Daniel, Chen Klaus, Krishnan Nithya, Hamer Rizwan, Briggs David
Transplant Unit, University Hospitals Coventry and Warwickshire, Coventry, West Midlands, UK.
Transplantation. 2007 Oct 15;84(7):876-84. doi: 10.1097/01.tp.0000284729.39137.6e.
Accommodation to antibody is an important mechanism in successful ABO-incompatible transplantation, but its importance in human leukocyte antigen (HLA) antibody-incompatible transplantation is less clear, as sensitive techniques facilitating daily measurement of donor-specific HLA antibodies (DSAs) have only recently been developed.
We report 24 patients who had HLA antibody-incompatible kidney transplantation (21 living donors, 3 deceased), 21 of whom had pretransplant plasmapheresis. Eight had positive complement-dependent cytotoxic (CDC) crossmatch (XM) pretransplant plasmapheresis, nine had positive flow cytometric (FC) XM, and seven had DSA detectable by microbead analysis only. After transplant, DSA levels were monitored closely with microbead assays.
Rejection occurred in five of eight (62.5%) CDC-positive cases, in three of nine (33%) FC-positive cases, and in two of seven (29%) of microbead-only cases at a median of 6.5 days after transplantation. Resolution occurred at a median of 15 days after transplantation, in 8 of 10 cases when the microbead level of DSA had median fluorescence intensity (MFI) >2000 U, in 6 of 10 when the microbead MFI >4000 U. In 8 of 10 cases, the microbead MFI at the time of resolution was greater than at the onset. DSA did not always cause clinical rejection. In five cases with a posttransplant DSA peaking at MFI >2000 U on microbead assay, rejection did not occur.
These data suggest that the dominant method of successful transplantation was function of the transplant in the presence of circulating DSA, and they also define the period during which this occurred.
抗体适应是成功进行ABO血型不相容移植的重要机制，但在人类白细胞抗原（HLA）抗体不相容移植中的重要性尚不清楚，因为有助于日常检测供体特异性HLA抗体（DSA）的敏感技术直到最近才得以开发。
我们报告了24例进行HLA抗体不相容肾移植的患者（21例活体供体，3例尸体供体），其中21例在移植前进行了血浆置换。8例在移植前血浆置换时补体依赖细胞毒（CDC）交叉配型（XM）呈阳性，9例流式细胞术（FC）XM呈阳性，7例仅通过微珠分析可检测到DSA。移植后，通过微珠分析密切监测DSA水平。
在CDC阳性的8例患者中，5例（62.5%）发生排斥反应；在FC阳性的9例患者中，3例（33%）发生排斥反应；在仅微珠分析阳性的7例患者中，2例（29%）在移植后中位6.5天发生排斥反应。排斥反应的缓解发生在移植后中位15天，当微珠DSA水平的中位荧光强度（MFI）>2000 U时，10例中有8例；当微珠MFI>4000 U时，10例中有6例。在10例中的8例中，缓解时的微珠MFI大于开始时。DSA并不总是导致临床排斥反应。在5例移植后微珠分析DSA峰值MFI>2000 U的患者中，未发生排斥反应。
这些数据表明，成功移植的主要方式是在循环DSA存在的情况下移植器官发挥功能，并且它们还确定了发生这种情况的时期。
