Division of Visceral and Transplant Surgery, University Hospital, Zurich, Switzerland.
Transplantation. 2010 Jul 27;90(2):160-7. doi: 10.1097/tp.0b013e3181e36e08.
This study evaluated the prognostic impact of pretransplant donor-specific anti-human leukocyte antigen antibodies (DSA) detected by single-antigen beads and compared the three generations of crossmatch (XM) tests in kidney transplantation.
Thirty-seven T-cell complement-dependent cytotoxicity crossmatch (CXM) negative living donor kidney recipients with a retrospectively positive antihuman leukocyte antigen antibody screening assay were included. A single-antigen bead test, a flow cytometry XM, and a Luminex XM (LXM) were retrospectively performed, and the results were correlated with the occurrence of antibody-mediated rejections (AMRs) and graft function.
We found that (1) pretransplant DSA against class I (DSA-I), but not against class II, are predictive for AMR, resulting in a sensitivity of 75% and a specificity of 90% at a level of 900 mean fluorescence intensity (MFI); (2) with increasing strength of DSA-I, the sensitivity for AMR is decreasing to 50% and the specificity is increasing to 100% at 5200 MFI; (3) the LXM for class I, but not for class II, provides a higher accuracy than the flow cytometry XM and the B-cell CXM. The specificity of all XMs is increased greatly in combination with DSA-I values more than or equal to 900 MFI.
In sensitized recipients, the best prediction of AMR and consecutively reduced graft function is delivered by DSA-I alone at high strength or by DSA-I at low strength in combination with the LXM or CXM.
本研究评估了通过单抗原珠检测到的移植前供体特异性抗人类白细胞抗原抗体（DSA）的预后影响，并比较了三代肾移植交叉配型（XM）试验。
纳入 37 例 T 细胞补体依赖性细胞毒性交叉配型（CXM）阴性的活体供肾受者，其抗人类白细胞抗原抗体筛查检测呈回顾性阳性。回顾性地进行了单抗原珠检测、流式细胞术 XM 和 Luminex XM（LXM），并将结果与抗体介导的排斥反应（AMR）和移植物功能相关联。
我们发现：（1）移植前针对 I 类（DSA-I）而非 II 类的 DSA 与 AMR 相关，其灵敏度为 75%，特异性为 90%，在 900 平均荧光强度（MFI）水平；（2）随着 DSA-I 强度的增加，AMR 的灵敏度降低至 50%，特异性升高至 5200 MFI 时的 100%；（3）I 类的 LXM 比流式细胞术 XM 和 B 细胞 CXM 具有更高的准确性，但 II 类的 LXM 没有。所有 XM 的特异性在与 DSA-I 值大于或等于 900 MFI 相结合时大大提高。
在致敏受者中，AMR 的最佳预测和随后的移植物功能降低是由高强度的 DSA-I 或低强度的 DSA-I 与 LXM 或 CXM 联合提供的。
