Department of Transplant and Endocrine Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
Department of Nephrology, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
Kidney Int. 2014 Feb;85(2):425-30. doi: 10.1038/ki.2013.291. Epub 2013 Aug 14.
The long-term effect of rituximab and splenectomy on de novo HLA antibody production and chronic antibody-mediated rejection after renal transplantation is uncertain. In order to gain insight on this, we studied 92 ABO-incompatible and 228 ABO-identical/compatible consecutive renal transplant patients and determined their de novo HLA antibody production and graft outcome. Patients with pretransplant donor-specific antibodies had been excluded. ABO-incompatible transplants included 30 recipients treated with rituximab, 51 by splenectomy, or 11 with neither, due to low anti-A or -B antibody titer. Graft survival in ABO-identical/compatible patients (97.7% at 5 years) was significantly higher than in ABO-incompatible (87.0% at 5 years), rituximab (96.7% at 3 years), or splenectomy (85.7% at 5 years) patients. Only four patients had clinical chronic antibody-mediated rejection (two each identical/compatible and incompatible). There was no significant difference in prevalence of de novo HLA antibody, including donor-specific and nondonor-specific antibodies among ABO-identical/compatible patients (13.9%), patients receiving rituximab (14.3%) or splenectomy (13.2%), or among those receiving cyclosporine, tacrolimus, mycophenolate mofetil, mizoribine, and everolimus. Renal function remained stable in most recipients with de novo HLA antibody. Thus, neither pretransplant splenectomy nor rituximab treatment has an inhibitory effect on de novo HLA antibody production during medium-term follow-up. Further study on long-term effects is needed.
利妥昔单抗和脾切除术对肾移植后新产生的 HLA 抗体和慢性抗体介导的排斥反应的长期影响尚不确定。为了深入了解这一点，我们研究了 92 例 ABO 不相容和 228 例 ABO 相同/相容的连续肾移植患者，并确定了他们新产生的 HLA 抗体和移植物结局。排除了具有移植前供体特异性抗体的患者。ABO 不相容的移植包括 30 例接受利妥昔单抗治疗、51 例接受脾切除术或 11 例未接受脾切除术的患者，原因是抗 A 或抗 B 抗体滴度较低。ABO 相同/相容患者的移植物存活率（5 年时为 97.7%）明显高于 ABO 不相容患者（5 年时为 87.0%）、利妥昔单抗患者（3 年时为 96.7%）或脾切除术患者（5 年时为 85.7%）。仅有 4 例患者发生临床慢性抗体介导的排斥反应（相同/相容和不相容各 2 例）。在 ABO 相同/相容患者（13.9%）、接受利妥昔单抗（14.3%）或脾切除术（13.2%）的患者以及接受环孢素、他克莫司、霉酚酸酯、米佐布津和依维莫司的患者中，新产生的 HLA 抗体（包括供体特异性和非供体特异性抗体）的患病率没有显著差异。大多数新产生 HLA 抗体的受者肾功能保持稳定。因此，在中期随访期间，脾切除术或利妥昔单抗治疗都没有抑制新产生的 HLA 抗体。需要进一步研究长期影响。
