Billen Evy V A, Christiaans Maarten H L, Lee Jarhow, van den Berg-Loonen Ella M
Tissue Typing Laboratory, University Hospital Maastricht, The Netherlands.
Transplantation. 2009 Feb 27;87(4):563-9. doi: 10.1097/TP.0b013e3181949e37.
Donor-directed antibodies (DDA) have been shown to result in poor graft survival. This study was designed to analyze antibody appearance and patient and graft characteristics related to antibody formation in patients who lost their graft at different time points after transplantation.
Pre- and posttransplant sera of 56 DDA-negative first transplant patients were screened for human leukocyte antigen (HLA) class I and II DDA by the Luminex single antigen assay (LSA). All patients were treated with calcineurine inhibitor-based immunosuppression.
Three of 56 patients proved DDA positive by LSA before transplantation. Eighty-one percent of the remaining 53 patients became DDA class I or II positive or both; 16% before and 84% after transplantectomy. Class I antibodies were produced in 84% and class II in 77% of the recipients. Based on time of transplantectomy, three groups were created as follows: less than or equal to 1 month, 1 to 6 months, and more than 6 months. The groups proved to be significantly different for HLA class II mismatch and acute rejection. All recipients in group 1 to 6 months proved to be DDA positive. Logistic regression analysis showed that DDA positivity for class I was related to higher donor age and donor type (nonheart beating), class II to higher donor age and class II mismatch.
Donor-directed HLA antibodies after transplantation were demonstrated in 81% of first transplant recipients, all of whom were DDA negative by LSA before transplantation. The majority of the antibodies was found after transplantectomy. These findings may have to be taken into consideration in the allocation of organs of marginal donors such as older or nonheart beating kidneys.
供体特异性抗体（DDA）已被证明会导致移植物存活率低下。本研究旨在分析抗体出现情况以及与移植后不同时间点移植物丢失患者抗体形成相关的患者和移植物特征。
通过Luminex单抗原检测法（LSA）对56例DDA阴性的首次移植患者移植前和移植后的血清进行人类白细胞抗原（HLA）Ⅰ类和Ⅱ类DDA筛查。所有患者均接受基于钙调神经磷酸酶抑制剂的免疫抑制治疗。
56例患者中有3例在移植前经LSA检测为DDA阳性。其余53例患者中有81%变为DDAⅠ类或Ⅱ类阳性或两者均阳性；移植切除术前为16%，术后为84%。84%的受者产生了Ⅰ类抗体，77%产生了Ⅱ类抗体。根据移植切除时间，分为以下三组：小于或等于1个月、1至6个月、大于6个月。这三组在HLAⅡ类错配和急性排斥反应方面存在显著差异。1至6个月组的所有受者均为DDA阳性。逻辑回归分析表明，Ⅰ类DDA阳性与供体年龄较大和供体类型（非心脏跳动供体）有关，Ⅱ类与供体年龄较大和Ⅱ类错配有关。
在81%的首次移植受者中证实了移植后供体特异性HLA抗体，所有这些受者在移植前经LSA检测均为DDA阴性。大多数抗体在移植切除后出现。在分配边缘供体（如年龄较大或非心脏跳动的肾脏）的器官时，可能需要考虑这些发现。
