Kobayashi Takaaki, Katayama Akio, Kohara Setsuko, Nagasaka Takaharu, Goto Norihiko, Ueki Tsuneo, Uchida Kazuharu, Nakao Akimasa
Department of Applied Immunology, Nagoya University School of Medicine, Nagoya, Japan.
Transplantation. 2008 Jun 15;85(11):1595-600. doi: 10.1097/TP.0b013e318170f79f.
Although the usefulness of posttransplant human leukocyte antigen (HLA) antibody monitoring has been demonstrated, detailed recommendations have not been worked out in its frequency, the type of patients and methods to be used. Enzyme-linked immunosorbent assay is a simple and cost-efficient assay. The urine protein test that reflects renal dysfunction is performed everywhere. We assessed the clinical value of HLA antibody and urine protein monitoring after renal transplantation.
Serum samples were consecutively collected from outpatients (n=323) in 2004 and in 2006. Because 18 had graft failure and 8 died with functioning graft for 2 years, 297 paired sera were tested for HLA antibody using enzyme-linked immunosorbent assay. Urine protein was determined to be positive when the dipstick protein reaction was+/-or over (20 mg/dL).
Total 297 patients were divided according to the change of HLA antibody status. Only patients with all of (i) de novo HLA antibody production, (ii) continuous detection from peripheral blood, and (iii) positive urine protein test had a significantly higher serum creatinine than the others and demonstrated rapid deterioration of Cr (DeltaCr 1.26 mg/dL during 2 years). Negative change of HLA antibody stopped the increase of serum creatinine.
The status of HLA antibody and urine protein provides useful information on graft prognosis. Although the tempo of graft injury is relatively slow, a yearly routine HLA antibody test for all patients and the attempt to reduce HLA antibody to negative levels is recommended, when HLA antibody is newly detected and urine protein test is positive.
尽管移植后人白细胞抗原（HLA）抗体监测的实用性已得到证实，但在监测频率、适用患者类型及监测方法方面，尚未制定出详细的建议。酶联免疫吸附测定是一种简单且成本效益高的检测方法。反映肾功能障碍的尿蛋白检测在各地均有开展。我们评估了肾移植后HLA抗体和尿蛋白监测的临床价值。
连续收集2004年和2006年门诊患者（n = 323）的血清样本。由于18例患者移植失败，8例患者在移植肾功能正常的情况下死亡，故对297对配对血清采用酶联免疫吸附测定法检测HLA抗体。当尿试纸蛋白反应为+/-或更高（20mg/dL以上）时，尿蛋白被判定为阳性。
根据HLA抗体状态的变化对297例患者进行分组。只有同时具备（i）新发HLA抗体产生、（ii）外周血持续检测到抗体以及（iii）尿蛋白检测呈阳性的患者，其血清肌酐水平显著高于其他患者，并显示肌酐快速恶化（2年内ΔCr为1.26mg/dL）。HLA抗体的阴性变化可阻止血清肌酐升高。
HLA抗体和尿蛋白状态可为移植预后提供有用信息。尽管移植损伤的进展相对缓慢，但建议对所有患者每年进行常规HLA抗体检测，当新检测到HLA抗体且尿蛋白检测呈阳性时，尝试将HLA抗体水平降至阴性。
