移植前具有供体特异性抗人类白细胞抗原抗体的肾移植受者的免疫风险评估。

Pretransplant immunologic risk assessment of kidney transplant recipients with donor-specific anti-human leukocyte antigen antibodies.

机构信息

1 Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY. 2 Department of Pharmacy, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY. 3 Renal Division, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY. 4 Department of Transplant Immunology and Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY. 5 Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY. 6 Address correspondence to: Enver Akalin, M.D., Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, The University Hospital of Albert Einstein College of Medicine, 111 East 210th St, Bronx, NY 10467.

出版信息

Transplantation. 2014 Nov 27;98(10):1082-8. doi: 10.1097/TP.0000000000000191.

DOI:10.1097/TP.0000000000000191

PMID:24873780

Abstract

BACKGROUND

Patients with pretransplantation strong donor-specific anti-human leukocyte antigen (HLA) antibodies (DSA) are at higher risk for rejection. We aimed to study the safety of kidney transplantation in patients with lower strength DSAs in a prospective cohort study.

METHODS

Three hundred and seventy-three consecutive adult kidney transplant recipients with (DSA+; n=66) and without (DSA-; n=307) DSA were evaluated. Anti-HLA antibodies with mean fluorescence intensity values over 5,000 for HLA-A, HLA-B, and HLA-DR and more than 10,000 for HLA-DQ were reported as unacceptable antigens. Patients received transplant if flow cytometry T-cell and B-cell cross-match channel shift values were less than 150 and 250, respectively, with antithymocyte globulin and intravenous immunoglobulin induction treatment.

RESULTS

Patients had a mean number of 1.6 ± 0.8 DSAs with a mean fluorescence intensity value of 2,815 ± 2,550. Twenty-seven percent were flow cytometry cross-match positive with T-cell and B-cell channel shift values of 129 ± 49 and 159 ± 52, respectively. During a median follow-up of 24 months (range, 6-50), there were no statistically significant differences in patient (99% vs. 95%) and graft survival (88% vs. 90%) rates between DSA+ and DSA- groups, respectively. Cumulative acute rejection rates of 11% in the DSA+ group and 12% in the DSA- group were similar. Two DSA+ (3%) and five DSA- (2%) patients developed chronic antibody-mediated rejection (3%). The mean serum creatinine levels were identical between the two groups (1.4 ± 0.6 mg/dL).

CONCLUSION

Similar patient and graft survival, and acute rejection rates can be achieved in DSA+ patients compared to DSA- patients with pretransplantation immunologic risk assessment.

摘要

背景

移植前存在强供体特异性抗人类白细胞抗原（HLA）抗体（DSA）的患者发生排斥反应的风险较高。我们旨在通过前瞻性队列研究来研究具有较低强度 DSA 的患者进行肾移植的安全性。

方法

评估了 373 例连续的成年肾移植受者，其中（DSA+；n=66）和没有（DSA-；n=307）DSA。HLA-A、HLA-B 和 HLA-DR 的平均荧光强度值超过 5000，HLA-DQ 的平均荧光强度值超过 10000 的抗 HLA 抗体被报告为不可接受的抗原。如果流式细胞术 T 细胞和 B 细胞交叉匹配通道移位值分别小于 150 和 250，并且使用抗胸腺细胞球蛋白和静脉注射免疫球蛋白诱导治疗，则患者接受移植。

结果

患者的平均 DSA 数量为 1.6±0.8 个，平均荧光强度值为 2815±2550。27%的患者流式细胞术交叉匹配阳性，T 细胞和 B 细胞通道的移位值分别为 129±49 和 159±52。在中位随访 24 个月（范围，6-50）期间，DSA+和 DSA-组患者（分别为 99%和 95%）和移植物存活率（分别为 88%和 90%）无统计学差异。DSA+组累积急性排斥反应率为 11%，DSA-组为 12%。2 例 DSA+（3%）和 5 例 DSA-（2%）患者发生慢性抗体介导的排斥反应（3%）。两组的平均血清肌酐水平相同（1.4±0.6mg/dL）。