Immunology department, Medical school, Hamadan University of Medical Sciences, Hamadan, Iran.
Transpl Immunol. 2012 Mar;26(2-3):81-7. doi: 10.1016/j.trim.2011.12.002. Epub 2011 Dec 13.
This retrospective study aims to determine the prognostic values of HLA and MICA antibodies, serum levels of sCD30 and soluble form of MHC class I related chain A (sMICA) in kidney allograft recipients.
Sera samples of 40 living unrelated donor kidney recipients were tested by ELISA and Flow beads techniques for the presence of anti HLA and MICA antibodies and the contents of sCD30 and sMICA. HLA and MICA antibody specification was performed by LABScreen single antigen beads to determine whether the antibodies were directed against donor mismatches.
Within first year post operatively 9 of 40 patients (22.5%) showed acute rejection episodes (ARE) that four of them lost their grafts compared to 31 functioning transplants (P=0.001). The presence of HLA antibodies before and after transplantation was significantly associated with ARE (P=0.01 and P=0.02 respectively). Sensitization to HLA class II antigens pre-transplant was strongly associated with higher incidence of ARE (P=0.004). A significant correlation was found between ARE and appearance of non-donor specific antibodies (P=0.02). HLA antibody positive patients either before or after transplantation showed lower graft survival rates than those without antibodies during three years follow-up (P=0.04 and P=0.02). Anti-MICA antibodies were observed in 8/40(20%) and 5/40(12.5%) of patients pre and post-transplant respectively. Coexistence of HLA and MICA antibodies was shown in 2 of 4 cases with graft loss. A significant increased level of sCD30 at day 14 (P=0.001) and insignificant decreased levels of sMICA pre and post operatively were detected in rejecting transplants compared to functioning graft group.
Our findings support the view that monitoring of HLA and MICA antibodies as well as sCD30 levels early after transplant has predictive value for early and late allograft dysfunctions and the presence of these factors are detrimental to graft function and survival.
本回顾性研究旨在确定 HLA 和 MICA 抗体、血清可溶性 CD30（sCD30）和主要组织相容性复合体 I 相关链 A 可溶性形式（sMICA）水平在肾移植受者中的预后价值。
采用 ELISA 和 Flow beads 技术检测 40 例活体非亲缘供肾受者血清中抗 HLA 和 MICA 抗体及 sCD30 和 sMICA 含量。采用 LABScreen 单抗原珠检测 HLA 和 MICA 抗体特异性，以确定抗体是否针对供者错配。
术后 1 年内，40 例患者中有 9 例（22.5%）发生急性排斥反应（ARE），其中 4 例患者移植肾丢失，而 31 例移植肾功能正常（P=0.001）。移植前后存在 HLA 抗体与 ARE 显著相关（P=0.01 和 P=0.02）。移植前致敏 HLA Ⅱ类抗原与 ARE 发生率较高密切相关（P=0.004）。ARE 与非供体特异性抗体的出现呈显著相关性（P=0.02）。移植前后存在 HLA 抗体的患者在 3 年随访期间的移植肾存活率低于无抗体患者（P=0.04 和 P=0.02）。移植前和移植后分别有 8/40（20%）和 5/40（12.5%）的患者出现抗-MICA 抗体。在 2 例移植肾丢失的病例中检测到 HLA 和 MICA 抗体共存。与功能正常的移植物组相比，发生排斥反应的移植物在术后第 14 天 sCD30 水平显著升高（P=0.001），而 sMICA 水平术前和术后无明显降低。
我们的研究结果支持这样一种观点，即移植后早期监测 HLA 和 MICA 抗体以及 sCD30 水平对早期和晚期移植物功能障碍具有预测价值，这些因素对移植物功能和存活有害。
