Department of Clinical Immunology, PathWest, Royal Perth Hospital, Western Australia, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, Australia.
Transpl Immunol. 2013 Dec;29(1-4):22-7. doi: 10.1016/j.trim.2013.09.008. Epub 2013 Sep 30.
Historic red blood cell transfusion (RBCT) may induce anti-HLA antibody which, if donor specific (DSA), is associated with increased antibody-mediated rejection (AMR). Whether post-operative RBCT influences this risk is unknown. We examined the RBCT history in 258 renal transplant recipients stratified according to prevalent recipient HLA antibody (DSA, Non-DSA or No Antibody). AMR occurred more frequently in patients who received RBCT both pre and post transplant compared with all other groups (Pre+Post-RBCT 21%, Pre-RBCT 4%, Post-RBCT 6%, No-RBCT 6%, HR 4.1 p=0.004). In the 63 patients who received Pre+Post-RBCT, 65% (13/20) with DSA developed AMR compared with 0/6 in the Non-DSA group and 2/37 (5%) in the No-Antibody group (HR 13.9 p<0.001). In patients who received No-RBCT, Pre-RBCT or Post-RBCT there was no difference in AMR between patients with DSA, Non-DSA or No-Antibody. Graft loss was independently associated with Pre+Post-RBCT (HR 6.5, p=0.001) AMR (HR 23.9 p<0.001) and Non-AMR (6.0 p=0.003) after adjusting for DSA and delayed graft function. Re-exposure to RBCT at the time of transplant is associated with increased AMR only in patients with preformed DSA, suggesting that RBCT provides additional allostimulation. Patients receiving Pre+Post-RBCT also had an increased risk of graft loss independently of AMR or DSA. Both pre and post procedural RBCT in renal transplantation is associated with modification of immunological risk and warrants additional study.
历史上的红细胞输血（RBCT）可能会引起抗 HLA 抗体，如果是供体特异性（DSA），则与抗体介导的排斥反应（AMR）增加有关。术后 RBCT 是否会影响这种风险尚不清楚。我们检查了 258 例肾移植受者的 RBCT 史，这些受者根据现有的受者 HLA 抗体（DSA、非 DSA 或无抗体）进行分层。与所有其他组相比，接受移植前和移植后 RBCT 的患者发生 AMR 的频率更高（Pre+Post-RBCT 21%、Pre-RBCT 4%、Post-RBCT 6%、No-RBCT 6%，HR 4.1，p=0.004）。在接受 Pre+Post-RBCT 的 63 例患者中，20 例有 DSA 的患者中有 65%（13/20）发生 AMR，而在非 DSA 组中无 1 例，在无抗体组中为 2/37（5%）（HR 13.9，p<0.001）。在接受 No-RBCT、Pre-RBCT 或 Post-RBCT 的患者中，在有 DSA、非 DSA 或无抗体的患者中，AMR 之间没有差异。在调整 DSA 和延迟移植物功能后，移植前和移植后 RBCT（HR 6.5，p=0.001）、AMR（HR 23.9，p<0.001）和非 AMR（HR 6.0，p=0.003）与移植物丢失独立相关。在预先形成的 DSA 患者中，移植时再次接触 RBCT 仅与 AMR 增加相关，这表明 RBCT 提供了额外的同种异体刺激。接受 Pre+Post-RBCT 的患者也有独立于 AMR 或 DSA 增加的移植物丢失风险。肾移植中术前和术后的 RBCT 均与免疫风险的改变相关，值得进一步研究。
