Peng David M, Law Yuk M, Kemna Mariska S, Warner Paul, Nelson Karen, Boucek Robert J
University of Washington/Seattle Children's Hospital, Seattle, WA, USA.
Pediatr Transplant. 2013 Aug;17(5):429-35. doi: 10.1111/petr.12075. Epub 2013 Mar 31.
There is limited evidence regarding the utility of circulating DSA in surveillance for AMR of pediatric heart recipients. Our hypothesis is that quantitation of DSA improves their power for predicting a C4d+, an integral component in the current diagnostic criteria of AMR. All pediatric recipients transplanted between 10/2005 and 1/2011 were retrospectively reviewed for DSA determined within 48 h of EMB. C4d+ was defined as >25% endothelial cell staining by immunohistochemical methods. A total of 183 paired DSA-EMB determinations were identified in 60 patients, a median of three paired studies per patient (range: 1-9). DSA were detected in 60 of these determinations. A receiver-operating characteristic plot identified a threshold single-antibody MFI of >6000 that strongly correlated with C4d+ (p < 0.0001) with a high negative predictive value (0.97) and specificity (0.95). The sensitivity and positive predictive values were 0.71 and 0.60, respectively. The predictive power of single-antigen DSA for C4d deposition was improved in pediatric heart recipients using an institution-specific MFI threshold value. In post-transplant care, quantitative DSA should be an essential component in the surveillance for AMR.
关于循环供者特异性抗体（DSA）在小儿心脏移植受者急性抗体介导排斥反应（AMR）监测中的作用，证据有限。我们的假设是，DSA定量分析可提高其预测C4d阳性的能力，C4d阳性是目前AMR诊断标准中的一个重要组成部分。对2005年10月至2011年1月期间接受移植的所有小儿受者进行回顾性研究，分析其在心肌活检（EMB）后48小时内检测的DSA。C4d阳性定义为免疫组化方法检测内皮细胞染色>25%。在60例患者中总共确定了183对DSA-EMB检测结果，每位患者平均有3对检测结果（范围：1-9）。在这些检测结果中有60例检测到DSA。通过绘制受试者工作特征曲线确定，单抗体平均荧光强度（MFI）>6000的阈值与C4d阳性密切相关（p<0.0001），具有较高的阴性预测值（0.97）和特异性（0.95）。敏感性和阳性预测值分别为0.71和0.60。使用机构特定的MFI阈值，单抗原DSA对小儿心脏移植受者C4d沉积的预测能力得到提高。在移植后护理中，定量DSA应成为AMR监测的重要组成部分。
