Jiangsu Institute of Hematology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China.
Chin Med J (Engl). 2013;126(15):2815-20.
Humoral immunity is an important factor for long-term survival of renal allograft. Here we performed a four-year follow-up to explore the clinical significance of monitoring anti-human leukocyte antigens (HLA) and anti-major histocompatibility complex class I-related chain A (MICA) antibody expression after kidney transplantation.
We obtained serial serum samples from 84 kidney transplant patients over a four-year period. All patients were followed up at least 6 months after transplantation and had at least two follow-up points. Anti-HLA and anti-MICA antibody titres and serum creatinine (SCr) levels were evaluated at each follow-up. Patients were divided into 4 groups: HLA(+) MICA(-), HLA(-)MICA(+), HLA(+)MICA(+) and HLA(-)MICA(-). The impact of post-transplant antibody level on kidney allograft function was evaluated.
Antibodies were detected in 38.1% (32/84) of the renal allograft recipients. HLA, MICA and HLA+MICA expression was observed in 18.89%, 14.44% and 5.93% of the recipients respectively. The most frequent anti-HLA and anti-MICA specific antibodies identified were A11, A24, A29, A32, A33, A80; B7, B13, B37; DR17, DR12, DR18, DR52, DR53, DR1, DR4, DR9, DR51; DQ7, DQ4, DQ8, DQ2, DQ9, DQ5, DQ6 and MICA02, MICA18, MICA19, MICA07, MICA27. As the time after transplantation elapsed, more recipients developed de novo antibody expression. Total 11.91% (10/84) of the recipients had de novo antibody expression during the follow up. The average level of SCr and the percentage of recipients with abnormal allograft function were significantly higher in recipients with anti-HLA and/or anti-MICA antibody expression than those without. The appearance of anti-HLA and anti-MICA antibody expression always preceded the increase in SCr value.
Anti-HLA and anti-MICA antibody expression has predictive value for early and late allograft dysfunction. The presence of donor specific antibody is detrimental to graft function and graft survival.
体液免疫是肾移植长期存活的一个重要因素。在此，我们进行了为期四年的随访，以探讨移植后监测抗人白细胞抗原（HLA）和抗主要组织相容性复合体Ⅰ类相关链 A（MICA）抗体表达的临床意义。
我们在四年期间从 84 例肾移植患者中获得了一系列血清样本。所有患者在移植后至少随访 6 个月，且至少有两个随访点。在每次随访时评估抗-HLA 和抗-MICA 抗体滴度和血清肌酐（SCr）水平。患者被分为 4 组：HLA（+）MICA（-）、HLA（-）MICA（+）、HLA（+）MICA（+）和 HLA（-）MICA（-）。评估移植后抗体水平对肾移植功能的影响。
在 84 例肾移植受者中，有 38.1%（32/84）检测到抗体。在受者中分别观察到 HLA、MICA 和 HLA+MICA 的表达率为 18.89%、14.44%和 5.93%。最常见的抗-HLA 和抗-MICA 特异性抗体分别为 A11、A24、A29、A32、A33、A80；B7、B13、B37；DR17、DR12、DR18、DR52、DR53、DR1、DR4、DR9、DR51；DQ7、DQ4、DQ8、DQ2、DQ9、DQ5、DQ6 和 MICA02、MICA18、MICA19、MICA07、MICA27。随着移植后时间的推移，越来越多的受者出现新的抗体表达。在随访期间，共有 11.91%（10/84）的受者出现新的抗体表达。与无 HLA 和/或抗-MICA 抗体表达的受者相比，有抗-HLA 和/或抗-MICA 抗体表达的受者的 SCr 平均值和异常移植功能受者的百分比明显更高。抗-HLA 和抗-MICA 抗体表达的出现总是先于 SCr 值的增加。
抗-HLA 和抗-MICA 抗体表达对早期和晚期移植物功能障碍具有预测价值。供体特异性抗体的存在不利于移植物功能和移植物存活。
