肾移植受者移植前供者特异性抗体弱阳性的临床结局
Clinical outcomes among renal transplant recipients with pre-transplant weakly reactive donor-specific antibodies.
作者信息
Yoo Peter S, Bonnel Alexander, Kamoun Malek, Levine Matthew H
机构信息
Department of Surgery, Section of Transplantation and Immunology, Yale University School of Medicine, New Haven, CT, USA.
出版信息
Clin Transplant. 2014 Jan;28(1):127-33. doi: 10.1111/ctr.12289. Epub 2013 Dec 18.
BACKGROUND
Alloantibody can lead to antibody-mediated rejection and graft loss in renal transplantation, necessitating an assessment of cross-match compatibility. Within the past decade, more specific solid phase assays of alloantibody have been widely adopted, allowing virtual cross-matching based on unacceptable antigens, the threshold of which is determined by individual centers.
METHODS
We examined the clinical outcomes of 482 patients transplanted 2007-2009 in a single center, focusing on 30 patients with weakly reactive donor-specific antibody (DSA) determined prospectively prior to renal transplant.
RESULTS
Compared with patients without DSA, patients with weakly reactive DSA do not have increased rates of antibody-mediated rejection, cellular rejection, or graft loss despite conventional immunosuppression utilization.
CONCLUSIONS
Using the screening methodology and immunosuppression regimen, we have applied to the patients with weak DSA allows them to be transplanted with equivalent outcomes as those without DSA, despite the overall higher risk characteristics of the patients in the weak DSA group.
背景
同种异体抗体可导致肾移植中抗体介导的排斥反应和移植物丢失，因此需要评估交叉配型的相容性。在过去十年中，更特异的同种异体抗体固相检测方法已被广泛采用，从而能够基于不可接受抗原进行虚拟交叉配型，其阈值由各个中心确定。
方法
我们研究了2007年至2009年在单一中心接受移植的482例患者的临床结局，重点关注30例在肾移植前前瞻性确定为供体特异性抗体（DSA）弱阳性的患者。
结果
与无DSA的患者相比，尽管使用了传统免疫抑制治疗，但DSA弱阳性患者的抗体介导排斥反应、细胞性排斥反应或移植物丢失发生率并未增加。
结论
采用我们应用于DSA弱阳性患者的筛查方法和免疫抑制方案，尽管DSA弱阳性组患者总体风险特征较高，但他们移植后的结局与无DSA患者相当。
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