Service de Pneumologie B et Transplantation Pulmonaire, Hôpital Bichat, Paris, France. olivier.brugie`
Transplantation. 2013 Mar 15;95(5):761-5. doi: 10.1097/TP.0b013e31827afb0f.
New methods of solid-phase assays, such as Luminex assay, with high sensitivity in detecting anti-human leukocyte antigen (HLA) antibodies (Abs), have increased the proportion of sensitized candidates waiting for lung transplantation (LTx). However, how to apply these results clinically during graft allocation is debated: strict exclusion of candidates with Luminex-positive results can lead to lost opportunities for Tx. We retrospectively analyzed the clinical impact of pre-LTx Luminex-detected Abs on post-LTx outcomes for patients who underwent LTx before the availability of Luminex assay.
We analyzed data for 56 successive patients who underwent LTx before 2008 and were considered to not have anti-HLA Abs by then-available methods of detection at the date of their LTx. Pre-LTx sera from these patients were retested by Luminex assay. Using log-rank test, freedom from bronchiolitis obliterans syndrome (BOS) and graft survival were compared between patients with and without pre-LTx Luminex-detected anti-HLA Abs classes I and II and donor-specific Abs (DSA) classes I and II.
Freedom from bronchiolitis obliterans syndrome was lower, and mortality was higher for patients with than those without pre-LTx Luminex-detected DSA class II (P=0.004 and P=0.007, respectively) but did not differ for patients with and without DSA class I or anti-HLA Abs class I or II.
It suggests to avoid attributing graft with forbidden antigens to sensitized candidates with Luminex-detected DSA class II and to evaluate the role of specific posttransplantation protocols for LTx candidates who require emergency LTx.
新型固相检测方法，如 Luminex 检测法，在检测抗人白细胞抗原（HLA）抗体（Abs）方面具有高灵敏度，这增加了等待肺移植（LTx）的致敏候选者的比例。然而，如何在供体分配过程中临床应用这些结果存在争议：严格排除 Luminex 检测阳性结果的候选者可能导致错失 Tx 机会。我们回顾性分析了在 Luminex 检测法应用之前接受 LTx 的患者的预 LTx Luminex 检测 Abs 对 post-LTx 结果的临床影响。
我们分析了 56 例连续接受 LTx 的患者的数据，这些患者在 2008 年之前接受 LTx，并且在他们接受 LTx 日期的当时可用的检测方法下被认为没有抗 HLA Abs。对这些患者的预 LTx 血清进行了 Luminex 检测。使用对数秩检验，比较了有和无预 LTx Luminex 检测到的 HLA Abs Ⅰ类和Ⅱ类以及供体特异性 Abs（DSA）Ⅰ类和Ⅱ类的患者的无支气管闭塞性细支气管炎综合征（BOS）和移植物存活率。
无 BOS 生存率较低，死亡率较高，与无预 LTx Luminex 检测到的 DSA Ⅱ类患者相比（分别为 P=0.004 和 P=0.007），但与无 DSA Ⅰ类或抗 HLA Abs Ⅰ类或Ⅱ类患者无差异。
这表明避免将带有禁止抗原的移植物分配给具有 Luminex 检测到的 DSA Ⅱ类的致敏候选者，并评估对于需要紧急 LTx 的 LTx 候选者的特定 posttransplantation 方案的作用。
