Heilman Raymond L, Nijim Ala, Desmarteau Yvonne M, Khamash Hasan, Pando Marcelo Jorge, Smith Maxwell L, Chakkera Harini A, Huskey Janna, Valdez Riccardo, Reddy Kunam Sudhakar
1 Department of Medicine, Mayo Clinic, Phoenix, AZ. 2 Department of Pathology and Laboratory Medicine, Mayo Clinic, Phoenix, AZ. 3 Department of Surgery, Mayo Clinic, Phoenix, AZ. 4 Address correspondence to: Raymond L. Heilman, M.D., Department of Medicine, Mayo Clinic, 5777 East Mayo Blvd, Phoenix, AZ 85054.
Transplantation. 2014 Dec 27;98(12):1310-5. doi: 10.1097/TP.0000000000000216.
Our aim was to determine the incidence of de novo donor-specific human leukocyte antigen (HLA) antibody (dnDSA) during the first year after kidney transplantation and the impact of early dnDSA on acute rejection and protocol biopsy findings.
We selected all patients who received a kidney transplant at our center between July 2010 and March 2012. Single antigen bead assay was performed at 1, 4 and 12 months after transplantation. Only DSAs with a mean fluorescence intensity (MFI) of greater 999 were included.
We included 245 kidney transplant recipients who did not have a DSA before transplantation. At 12 months, 8.2% of the patients developed dnDSA; 2.4% of them were to HLA class I and 6.5% to HLA class II. Of the 32 patients with a dnDSA at 1 or 4 months, only 8 (25%) persisted at 12 months. The risk of antibody-mediated rejection (AMR) was higher in the dnDSA group. For the dnDSA group with MFI of 3,000 or greater (compared with the group with MFI<3,000), the hazard ratio for AMR was 10.6 (95% confidence interval, 2.27-49.5). The cumulative incidence of AMR or mixed rejection at 1 year was 30% in the group with dnDSA MFI level of 3,000 or greater but only 4% for the group with dnDSA with MFI less than 3,000. On 1-year protocol biopsies, the dnDSA group showed more interstitial inflammation, tubulitis, and glomerulitis.
We conclude that dnDSA occurring during the first posttransplantation year may be transient, and the risk of AMR is higher in patients with a dnDSA MFI level that is greater than 3,000.
我们的目的是确定肾移植后第一年新发供者特异性人类白细胞抗原（HLA）抗体（dnDSA）的发生率，以及早期dnDSA对急性排斥反应和方案活检结果的影响。
我们选取了2010年7月至2012年3月在本中心接受肾移植的所有患者。在移植后1个月、4个月和12个月进行单抗原珠检测。仅纳入平均荧光强度（MFI）大于999的DSA。
我们纳入了245例移植前无DSA的肾移植受者。在12个月时，8.2%的患者出现dnDSA；其中2.4%针对HLA I类，6.5%针对HLA II类。在1个月或4个月时出现dnDSA的32例患者中，只有8例（25%）在12个月时仍存在。dnDSA组抗体介导的排斥反应（AMR）风险更高。对于MFI为3000或更高的dnDSA组（与MFI<3000的组相比），AMR的风险比为10.6（95%置信区间，2.27 - 49.5）。dnDSA MFI水平为3000或更高的组在1年时AMR或混合排斥反应的累积发生率为30%，而dnDSA MFI小于3000的组仅为4%。在1年方案活检中，dnDSA组显示出更多的间质炎症、肾小管炎和肾小球炎。
我们得出结论，移植后第一年出现的dnDSA可能是短暂的，且dnDSA MFI水平大于3000的患者发生AMR的风险更高。
