供者特异性 HLA 抗体与儿童肾移植后移植物功能。
Donor-specific HLA antibodies and graft function in children after renal transplantation.
机构信息
Children’s Hospital, University of Helsinki and Helsinki University Central Hospital, Stenbackinkatu 11, 00290 Helsinki, Finland.
出版信息
Pediatr Nephrol. 2012 Jun;27(6):1011-9. doi: 10.1007/s00467-012-2101-4. Epub 2011 Oct 13.
BACKGROUND
The presence of circulating donor-specific human leukocyte antigen antibodies (HLA-DSA) has been associated with chronic antibody-mediated rejection, leading to progressive graft dysfunction and poor graft survival.The aim of this study was to investigate the incidence and significance of HLA-DSA in paediatric renal transplantation(RTx) patients.
METHODS
A total of 294 post-transplant serum samples from 123 RTx patients were retrospectively analysed for HLA antibodies. Positive samples were further tested for HLADSA by a Luminex Single Antigen bead assay. The antibody findings were correlated to measured glomerular filtration rate(GFR) and clinical outcome.
RESULTS
HLA antibodies were detected in half of the routine samples (140/294) taken 1 month to 10 years after RTx, and 40% (62/140) of these were HLA-DSA. Overall, one-third(42/123) of the patients had HLA-DSA, which mostly(65%) reacted against class II antigens. Detection of HLADSA was not associated with poor GFR at the time of sampling, and no exceptional deterioration of GFR after the HLA-DSA detection was noted in individual patients regardless of the antibody level. The presence of HLA-DSA in the first 2 years posttransplantation was not associated with poorer graft function later on.
CONCLUSION
Detection of HLA antibodies is common in children after RTx, and this finding, as such, does not predict any deterioration of graft function.
背景
循环供体特异性人类白细胞抗原抗体（HLA-DSA）的存在与慢性抗体介导的排斥反应有关，导致进行性移植物功能障碍和移植物存活率降低。本研究旨在探讨 HLA-DSA 在儿科肾移植（RTx）患者中的发生率和意义。
方法
回顾性分析了 123 例 RTx 患者的 294 份移植后血清样本，检测 HLA 抗体。对阳性样本进一步进行 Luminex 单抗原珠分析，以检测 HLA-DSA。将抗体检测结果与肾小球滤过率（GFR）和临床结果进行相关性分析。
结果
在 RTx 后 1 个月至 10 年内采集的常规样本中，有一半（140/294）检测到 HLA 抗体，其中 40%（62/140）为 HLA-DSA。总体而言，三分之一（42/123）的患者存在 HLA-DSA，其中 65%主要针对 II 类抗原。HLA-DSA 的检测与采样时的 GFR 不佳无关，并且在个别患者中，无论抗体水平如何，在 HLA-DSA 检测后均未注意到 GFR 异常恶化。移植后 2 年内 HLA-DSA 的存在与随后移植物功能的恶化无关。
结论
在 RTx 后，儿童中检测到 HLA 抗体很常见，但这一发现并不能预测移植物功能的任何恶化。
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