Tambur Anat R, Leventhal Joseph, Kaufman Dixon B, Friedewald John, Miller Joshua, Abecassis Michael M
Division of Organ Transplantation, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
Transplantation. 2008 Oct 27;86(8):1052-9. doi: 10.1097/TP.0b013e3181874b06.
Patients with human leukocyte antigen antibodies constitute a significantly disadvantaged population among those awaiting renal transplantation. We speculated that more understanding of the patients' antibody makeup would allow a more "immunologic" evaluation of crossmatch data, facilitate the use of virtual crossmatch (XM), and lead to more transplantability of these patients.
We retrospectively compared the transplantability and transplant outcome of two consecutive patient populations transplanted in our center. Group I (n=374) was evaluated using solid-phase base testing for determination of percentage panel reactive antibody ("PRA screen") with limited antibody identification testing. Group II (n=333) was tested in a more comprehensive manner with major emphasis on antibody identification, antibody strength assignment, and the use of pronase for crossmatch.
Given this approach, 49% (166/333) of the transplanted patients in group II were sensitized compared with 40% (150/374) of the recipients in group I; P=0.012. Transplant outcome at 1-year posttransplant was similar in both groups.
We conclude that comprehensive evaluation of human leukocyte antigen sensitization and application of immunologic in analyzing compatibility between donor and recipient can increase the transplantability of sensitized patients while maintaining similar outcome. Our approach is in line with United Network for Organ Sharing new guidelines for calculated panel reactive antibody and virtual XM analysis. We hope this report will prompt additional transplant programs to consider how they will use the new United Network for Organ Sharing algorithms.
在等待肾移植的患者中，携带人类白细胞抗原抗体的患者群体处于明显不利地位。我们推测，对患者抗体构成有更多了解将有助于对交叉配型数据进行更“免疫”的评估，促进虚拟交叉配型（XM）的应用，并提高这些患者的移植可能性。
我们回顾性比较了在本中心接受移植的两个连续患者群体的移植可能性和移植结果。第一组（n = 374）采用固相基础检测来确定群体反应性抗体百分比（“PRA筛查”），抗体鉴定检测有限。第二组（n = 333）采用更全面的检测方法，主要侧重于抗体鉴定、抗体强度赋值以及使用链霉蛋白酶进行交叉配型。
采用这种方法，第二组中49%（166/333）的移植患者致敏，而第一组中致敏受者为40%（150/374）；P = 0.012。两组移植后1年的移植结果相似。
我们得出结论，对人类白细胞抗原致敏情况进行全面评估，并在分析供受者相容性时应用免疫学方法，可以提高致敏患者的移植可能性，同时保持相似的结果。我们的方法符合器官共享联合网络关于计算群体反应性抗体和虚拟XM分析的新指南。我们希望本报告能促使更多移植项目考虑如何使用器官共享联合网络的新算法。
