Service de Néphrologie-Transplantation Adulte, Hôpital Necker-Enfants Malades, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, Paris, France.
Am J Transplant. 2014 Jun;14(6):1439-45. doi: 10.1111/ajt.12709. Epub 2014 May 7.
Anti-HLA donor-specific antibodies (DSAs) cause acute and chronic antibody-mediated rejection (AMR). However, the clinical relevance of anti-HLA-C antibodies remains unclear. We evaluated the clinical relevance of the presence of anti-HLA-C DSA at day 0 in renal transplant recipients. In this retrospective, case-controlled study, 608 patients who underwent kidney transplantation between August 2008 and March 2012 were screened for the presence of isolated anti-HLA-C DSA at day 0. A total of 22 renal transplant recipients were selected and followed for a period of 1 year. AMR was classified according to the Banff classification. The 22 patients were compared with 88 immunized patients. Acute AMR was diagnosed in six patients (27.3%). The median level of DSA at day 0 was 1179 (530-17,941). The mean fluorescence intensity in the anti-C group was 4966 (978-17,941) in the AMR group and 981 (530-8012) in the group of patients without AMR. Acute AMR was diagnosed less frequently in the 88 immunized individuals (9.1%) than in the DSA anti-C group (p = 0.033). The level of DSA at day 0 was predictive for AMR (p = 0.017). Patients with a high level of pretransplant anti-HLA-C DSAs are likely to develop acute AMR during the first year after transplantation.
抗 HLA 供体特异性抗体（DSA）可引起急性和慢性抗体介导的排斥反应（AMR）。然而，抗 HLA-C 抗体的临床相关性尚不清楚。我们评估了肾移植受者移植当天存在抗 HLA-C DSA 的临床相关性。在这项回顾性病例对照研究中，筛选了 2008 年 8 月至 2012 年 3 月期间接受肾移植的 608 例患者，以确定他们在移植当天是否存在抗 HLA-C DSA。共选择了 22 名肾移植受者，并随访了 1 年。根据 Banff 分类法对 AMR 进行分类。将这 22 名患者与 88 名免疫患者进行比较。6 名患者（27.3%）被诊断为急性 AMR。移植当天 DSA 的中位数水平为 1179（530-17,941）。在 AMR 组中，抗-C 组的平均荧光强度为 4966（978-17,941），而在无 AMR 组中为 981（530-8012）。在 88 名免疫患者中，急性 AMR 的诊断频率低于 DSA 抗-C 组（9.1%）（p=0.033）。移植当天的 DSA 水平与 AMR 相关（p=0.017）。移植前高水平的抗 HLA-C DSA 患者在移植后 1 年内可能发生急性 AMR。
