Ishida Hideki, Furusawa Miyuki, Shimizu Tomokazu, Nozaki Taiji, Tanabe Kazunari
Department of Urology, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan.
Transpl Int. 2014 Apr;27(4):371-82. doi: 10.1111/tri.12267.
We investigated the relationship between preoperative anti-HLA antibodies (donor-specific antibody, DSA) and the graft survival rate in recipients who had or had not received rituximab (Rit) treatment. The subjects were categorized into four groups as follows: DSA+Rit-, n = 39; DSA-Rit-, n = 121; DSA+Rit+, n = 74; and DSA-Rit+, n = 47. We examined the influence of preoperative DSA on the incidence of graft rejection and the survival rate of recipients who had or who had not received rituximab before transplantation. The 6-month acute rejection rates based on graft biopsies were 39%, 19%, 15%, and 0% for the DSA+Rit-, DSA-Rit-, DSA+Rit+, and DSA-Rit+ groups. The rates of chronic antibody-mediated rejection after more than 6 months were 50%, 22%, 18%, and 0%. The 5-year graft survival rate was significantly lower in the DSA+Rit- group (84%) than in the other groups (95% for DSA-Rit-, 98% for DSA+Rit+, and 91% for DSA-Rit+). The rate of the appearance of de novo anti-HLA antibodies was higher in the groups that did not receive rituximab treatment. The rate of graft loss associated with chronic antibody-mediated rejection was also higher in the DSA+Rit- group than in the other groups (P = 0.01). The presence of DSA and the administration of rituximab had strong impacts on not only short-term graft rejection, but also long-term graft rejection and its association with the graft survival time.
我们研究了术前抗人白细胞抗原抗体（供者特异性抗体，DSA）与接受或未接受利妥昔单抗（Rit）治疗的受者移植物存活率之间的关系。受试者被分为以下四组：DSA+Rit-组，n = 39；DSA-Rit-组，n = 121；DSA+Rit+组，n = 74；DSA-Rit+组，n = 47。我们研究了术前DSA对移植前接受或未接受利妥昔单抗的受者移植物排斥发生率和存活率的影响。基于移植活检的6个月急性排斥率在DSA+Rit-组、DSA-Rit-组、DSA+Rit+组和DSA-Rit+组中分别为39%、19%、15%和0%。6个月以上的慢性抗体介导排斥率分别为50%、22%、18%和0%。DSA+Rit-组的5年移植物存活率（84%）显著低于其他组（DSA-Rit-组为95%，DSA+Rit+组为98%；DSA-Rit+组为91%）。未接受利妥昔单抗治疗的组中，新生抗人白细胞抗原抗体的出现率更高。DSA+Rit-组中与慢性抗体介导排斥相关的移植物丢失率也高于其他组（P = 0.01）。DSA的存在和利妥昔单抗治疗不仅对短期移植物排斥有强烈影响，而且对长期移植物排斥及其与移植物存活时间的关联也有强烈影响。
