Nephrology Department, Bellvitge Biomedical Research Institute, Bellvitge University Hospital-ICS, Barcelona, Spain.
Transplantation. 2011 Sep 15;92(5):536-42. doi: 10.1097/TP.0b013e3182283c58.
Detection of markers predicting allograft rejection is important for risk assessment before kidney transplantation, as well as to minimize posttransplantation immunosuppression.
We studied the expression of CD25, HLA-DR, CD134, CD62L, and CD44 by flow cytometry in CD4, CD8, and CD3 cells, from pretransplant blood samples from 91 transplanted patients accounting for 16 episodes of acute renal rejection in the first month after transplantation.
None of the activation markers showed a significant association to acute rejection. Early rejectors showed less pretransplant CD3CD25 cells than nonrejectors (0.79%±0.50% vs. 1.51%±0.79% of CD3 cells; P=0.001) and a lower CD3CD25/CD3HLA-DR ratio (0.043±0.034 vs. 0.111±0.079; P<0.00001). When levels of CD25 cells fell below 0.7% of CD3 cells, the odds ratio of suffering an episode of acute rejection was 105 fold (95% confidence interval: 11.41-966.43, P<0.0001), with a sensitivity (true-positive results) of 0.63 and a specificity (true-negative results) of 0.98 for predicting the risk of acute rejection. Furthermore, when the CD3CD25/CD3HLA-DR ratio fell below 0.04, the odds ratio of suffering an episode of acute rejection was 7.71 fold (95% confidence interval: 2.29-25.97, P=0.001), with a sensitivity of 0.56 and a specificity of 0.86 for predicting risk of acute rejection.
Our results suggest that low pretransplant levels of CD3CD25 cells or a low CD3CD25/CD3HLA-DR ratio could identify those patients with an increased risk of early acute allograft rejection. If these data can be independently confirmed, pretransplant CD3CD25 cells and the CD3CD25/CD3HLA-DR ratio might provide additional information for risk assessment before kidney transplantation.
在肾移植前，检测预测移植物排斥的标志物对于风险评估很重要，同时也有助于减少移植后的免疫抑制。
我们通过流式细胞术研究了 91 例移植患者的 CD4、CD8 和 CD3 细胞中 CD25、HLA-DR、CD134、CD62L 和 CD44 的表达，这些患者的血样来自移植前，共 16 例发生在移植后第一个月的急性肾排斥反应。
没有一种激活标志物与急性排斥反应有显著关联。早期排斥者的移植前 CD3CD25 细胞比非排斥者少（0.79%±0.50%比 1.51%±0.79%的 CD3 细胞；P=0.001），且 CD3CD25/CD3HLA-DR 比值更低（0.043±0.034 比 0.111±0.079；P<0.00001）。当 CD25 细胞水平降至 CD3 细胞的 0.7%以下时，发生急性排斥反应的几率为 105 倍（95%置信区间：11.41-966.43，P<0.0001），其预测急性排斥反应风险的灵敏度（真阳性结果）为 0.63，特异性（真阴性结果）为 0.98。此外，当 CD3CD25/CD3HLA-DR 比值降至 0.04 以下时，发生急性排斥反应的几率为 7.71 倍（95%置信区间：2.29-25.97，P=0.001），其预测急性排斥反应风险的灵敏度为 0.56，特异性为 0.86。
我们的结果表明，移植前 CD3CD25 细胞水平较低或 CD3CD25/CD3HLA-DR 比值较低可识别出早期急性同种异体移植物排斥风险增加的患者。如果这些数据能够得到独立证实，移植前 CD3CD25 细胞和 CD3CD25/CD3HLA-DR 比值可能为肾移植前的风险评估提供额外信息。
