Department of Surgerya, University of Minnesota, Minneapolis, MN, USA.
Am J Transplant. 2011 Oct;11(10):2132-43. doi: 10.1111/j.1600-6143.2011.03640.x. Epub 2011 Aug 3.
Single-antigen bead (SAB) testing permits reassessment of immunologic risk for kidney transplantation. Traditionally, high panel reactive antibody (PRA), retransplant and deceased donor (DD) grafts have been associated with increased risk. We hypothesized that this risk was likely mediated by (unrecognized) donor-specific antibody (DSA). We grouped 587 kidney transplants using clinical history and single-antigen bead (SAB) testing of day of transplant serum as (1) unsensitized; PRA = 0 (n = 178), (2) third-party sensitized; no DSA (n = 363) or (3) donor sensitized; with DSA (n = 46), and studied rejection rates, death-censored graft survival (DCGS) and risk factors for rejection. Antibody-mediated rejection (AMR) rates were increased with DSA (p < 0.0001), but not with panel reactive antibody (PRA) in the absence of DSA. Cell-mediated rejection (CMR) rates were increased with DSA (p < 0.005); with a trend to increased rates when PRA>0 in the absence of DSA (p = 0.08). Multivariate analyses showed risk factors for AMR were DSA, worse HLA matching, and female gender; for CMR: DSA, PRA>0 and worse HLA matching. AMR and CMR were associated with decreased DCGS. The presence of DSA is an important predictor of rejection risk, in contrast to traditional risk factors. Further development of immunosuppressive protocols will be facilitated by stratification of rejection risk by donor sensitization.
单抗原珠 (SAB) 检测可重新评估肾移植的免疫风险。传统上，高面板反应性抗体 (PRA)、再次移植和已故供体 (DD) 移植物与风险增加相关。我们假设这种风险可能是由 (未识别的) 供体特异性抗体 (DSA) 介导的。我们根据临床病史和移植当天血清的单抗原珠 (SAB) 检测结果，将 587 例肾移植分为三组：(1) 未致敏；PRA = 0(178 例)；(2) 第三方致敏；无 DSA(363 例)或 (3) 供体致敏；有 DSA(46 例)，并研究排斥反应率、死亡相关移植物存活率 (DCGS) 和排斥反应的危险因素。DSA 存在时，抗体介导的排斥反应 (AMR) 发生率增加 (p < 0.0001)，但在无 DSA 时，面板反应性抗体 (PRA) 不存在时则不然。细胞介导的排斥反应 (CMR) 发生率随着 DSA 的增加而增加 (p < 0.005)；在无 DSA 时 PRA>0 存在时，有增加的趋势 (p = 0.08)。多变量分析显示，AMR 的危险因素是 DSA、HLA 配型较差和女性；CMR 的危险因素是 DSA、PRA>0 和 HLA 配型较差。AMR 和 CMR 与 DCGS 降低相关。与传统危险因素相比，DSA 的存在是排斥反应风险的重要预测因素。通过对供体致敏进行排斥风险分层，将有助于进一步制定免疫抑制方案。
