等待肾移植患者的 HLA 匹配血液输血的影响。

Effects of HLA-matched blood transfusion for patients awaiting renal transplantation.

机构信息

Northern Ireland Histocompatibility and Immunogenetics Laboratory, Belfast City Hospital, Belfast, Northern Ireland.

出版信息

Transplantation. 2012 Dec 15;94(11):1111-6. doi: 10.1097/TP.0b013e318271d776.

DOI:10.1097/TP.0b013e318271d776

PMID:23111496

Abstract

BACKGROUND

HLA sensitization in potential renal transplant recipients hinders opportunities of receiving suitable organs. To alleviate this, we sought to determine if supplying closely HLA Class I matched leukodepleted blood would minimize sensitization.

METHODS

Patients received HLA selected or random units of packed red cells. Selected units were sourced from blood donors included in the British Bone Marrow Registry and had no HLA-A and HLA-B mismatches where available, or alternatively, no HLA antigens with more than five immunogenic triplet mismatches as determined by the HLA-Matchmaker algorithm. Posttransfusion antibody screening confirmed development of de novo Class I and Class II HLA-specific IgG antibody(s) or increases in preexisting antibody levels of at least 20%.

RESULTS

Thirty-seven and 31 patients received HLA selected (mean, 2.5 units) and random (mean, 3.4 units) blood, respectively. A total of 20 of 37 (54.1%) patients receiving selected units and 10 of 31 (32.3%) patients receiving random units were previously sensitized. No patient receiving HLA selected units demonstrated any change in antibody levels. In patients who received random units, 7 of 31 demonstrated changes in antibody levels with three developing de novo HLA-specific antibodies and four an increase in panel reactive antibody (PRA) of at least 20% (P=0.002).

CONCLUSIONS

The risk of developing HLA-specific antibody is significantly reduced in renal patients awaiting transplantation when transfused with HLA selected units of blood compared with random units. With planning, access to HLA typed blood is achievable as many blood transfusion centers recruit donors for stem cell donor registries.

摘要

背景

潜在肾移植受者的 HLA 致敏会阻碍其获得合适器官的机会。为了解决这个问题，我们试图确定提供紧密 HLA Ⅰ类匹配的去白细胞血液是否会最小化致敏。

方法

患者接受 HLA 选择或随机的单位浓缩红细胞输注。选择的单位来源于英国骨髓登记处的献血者，在有条件的情况下，与受者 HLA-A 和 HLA-B 无错配，或者，根据 HLA-Matchmaker 算法，与具有超过五个免疫原性三联体错配的 HLA 抗原无错配。输血后抗体筛查证实了新产生的Ⅰ类和Ⅱ类 HLA 特异性 IgG 抗体或至少 20%的预先存在抗体水平升高。

结果

37 名和 31 名患者分别接受了 HLA 选择（平均 2.5 单位）和随机（平均 3.4 单位）血液。在接受选择单位的 37 名患者中，共有 20 名（54.1%）和接受随机单位的 31 名患者中的 10 名（32.3%）以前致敏。没有接受 HLA 选择单位的患者显示出任何抗体水平的变化。在接受随机单位的患者中，有 31 名患者中的 7 名显示出抗体水平的变化，其中 3 名患者产生新的 HLA 特异性抗体，4 名患者 panel reactive antibody（PRA）增加至少 20%（P=0.002）。