Renal Division, Recanati/Miller Transplantation Institute, New York, NY, USA.
Clin Transplant. 2009 Nov-Dec;23(6):951-7. doi: 10.1111/j.1399-0012.2009.01036.x. Epub 2009 Jul 13.
The aim of this study is to investigate the prevalence, predictors, and clinical outcomes of acute antibody-mediated rejection (AAMR).
Retrospective analysis of 833 adult patients who received kidney transplantation between 1/1/2001 and 8/15/2007.
The prevalence of AAMR and acute cellular rejection was 2% and 8.2%, respectively. Eight patients had type I, seven type II, and two type III AAMR. All patients had at least one strong donor-specific anti-HLA antibodies (DSA) with a median fluorescence intensity (MFI) value of over 6000 and the mean number of strong DSAs was 2.0 +/- 0.7. Fifteen of 17 patients received pre-transplant desensitization treatment. During a median 28 months of follow-up (range: 12-38 months), two patients died (88% patient survival), and nine lost their allografts (35% graft survival). While all type I AAMR patients responded to treatment, all type III patients, and four of seven patients with type II AAMR lost their allografts earlier, and three type II AAMR patients later due to transplant glomerulopathy.
AAMR is mainly seen in patients with pre-transplant strong DSAs. There is a striking difference in clinical outcomes of AAMR that types II and III AAMR patients have poor prognosis compared to type I AAMR patients.
本研究旨在探讨急性抗体介导的排斥反应（AAMR）的患病率、预测因素和临床结果。
回顾性分析 2001 年 1 月 1 日至 2007 年 8 月 15 日期间接受肾移植的 833 例成年患者。
AAMR 和急性细胞性排斥反应的患病率分别为 2%和 8.2%。8 例患者发生 1 型、7 例发生 2 型和 2 例发生 3 型 AAMR。所有患者均至少有一种强供体特异性 HLA 抗体（DSA），其中位荧光强度（MFI）值超过 6000，强 DSA 的平均数量为 2.0+/-0.7。17 例患者中有 15 例接受了移植前脱敏治疗。在中位数为 28 个月（范围：12-38 个月）的随访期间，2 例患者死亡（88%患者存活），9 例患者失去移植物（35%移植物存活）。虽然所有 1 型 AAMR 患者对治疗有反应，但所有 3 型患者以及 7 例 2 型 AAMR 患者中的 4 例更早失去移植物，3 例 2 型 AAMR 患者因移植肾小球病而较晚失去移植物。
AAMR 主要见于移植前有强 DSA 的患者。AAMR 的临床结果存在显著差异，与 1 型 AAMR 患者相比，2 型和 3 型 AAMR 患者的预后较差。
