Seattle Cancer Care Alliance, Clinical Research Division, Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA.
Hum Immunol. 2011 Jun;72(6):492-8. doi: 10.1016/j.humimm.2011.02.012. Epub 2011 Mar 9.
Pre-transplant screening of a woman with end-stage renal disease (ESRD) showed no anti-human leukocyte antigen (HLA) alloantibodies by anti-human globulin-complement-dependent cytotoxicity (AHG-CDC; class I) or enzyme-linked immunosorbent assay (class II). Following a negative AHG-CDC crossmatch, an HLA01:01+ deceased donor (DD) kidney was transplanted in September 2005. Subsequent screening of pre-transplant serum by LABScreen Single Antigen (SA) array showed strong reactivity versus A01:01. Despite that reactivity, at 5 years post-transplant, the patient has a serum creatinine of 1.6 mg/dl and has never experienced humoral or cellular rejection. Retrospective flow-cytometric crossmatch of pre- and post-transplant sera versus DD cells was negative. Rescreening of multiple pre- and post-transplant sera revealed anti-A1 reactivity persisting from the first through the last samples tested. The patient's anti-A1 was almost two fold more reactive with denatured A*01:01 FlowPRA SA beads after denaturation with acid treatment (pH 2.7) than with untreated beads. Parallel results were observed with pH 2.7 treated versus untreated A1+ T cells in FXM. These data highlight the difficulty in interpreting screening results obtained using bead arrays, because of antibodies that appear to recognize denatured but not native class I HLA antigens. We suggest that such bead-positive, flow cytometric crossmatch negative antibodies are not associated with humoral rejection, may not necessarily be detrimental to a graft, and deserve further evaluation before becoming a barrier to transplantation.
一位终末期肾病（ESRD）女性患者在移植前的筛查中，抗人球蛋白-补体依赖性细胞毒性（AHG-CDC；I 类）或酶联免疫吸附试验（ELISA；II 类）均未显示出抗人类白细胞抗原（HLA）同种抗体。在 AHG-CDC 交叉配型阴性后，于 2005 年 9 月移植了 HLA01:01+的已故供体（DD）肾脏。随后通过 LABScreen 单抗原（SA）阵列对移植前血清进行的进一步筛查显示对 A01:01 具有强烈的反应性。尽管存在这种反应性，但在移植后 5 年，患者的血清肌酐为 1.6mg/dl，且从未经历过体液或细胞排斥反应。对供体和移植后血清进行回顾性流式细胞交叉配型与 DD 细胞均为阴性。对多个移植前和移植后血清的重新筛查显示，抗 A1 反应性从第一次测试到最后一次测试的样本均持续存在。经过酸处理（pH 2.7）使 A01:01 变性后，患者的抗 A1 与未处理的珠子相比，与变性的 A01:01 FlowPRA SA 珠子的反应性几乎增加了两倍。在 FXM 中，用 pH 2.7 处理的 A1+T 细胞与未经处理的细胞相比，也观察到了类似的结果。这些数据突出了使用珠子阵列获得的筛选结果解释的困难，因为这些抗体似乎识别变性但不识别天然的 I 类 HLA 抗原。我们建议，对于这些珠子阳性、流式细胞交叉配型阴性的抗体，不与体液排斥反应相关，可能不一定对移植物有害，并且在成为移植的障碍之前，值得进一步评估。
