Huber Lu, Lachmann Nils, Niemann Matthias, Naik Marcel, Liefeldt Lutz, Glander Petra, Schmidt Danilo, Halleck Fabian, Waiser Johannes, Brakemeier Susanne, Neumayer Hans H, Schönemann Constanze, Budde Klemens
Section of Nephrology, Department of Medicine, Georgia Regents University Medical Centre, Augusta, GA, USA.
Center for Transfusion Medicine and Cell Therapy, Regional Tissue Typing Laboratory, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany.
Transpl Int. 2015 Jun;28(6):710-9. doi: 10.1111/tri.12533.
Virtual panel-reactive antibodies (vPRA) have been implemented to gauge sensitization worldwide. It is unclear how it associates with long-term outcomes, and its correlation with peak (pPRA) or actual (aPRA) has not been studied. We retrospectively reviewed data from 18- to 65-year-old kidney-only transplant patients during 1.1.1996-31.7.2011 in our center. PRAs were calculated based on solid-phase techniques. Of the 726 qualified cases, regardless of the PRA type, sensitized patients (PRA > 5%) had more females and previous transplant. Highly sensitized (HS, PRA > 50%) had longer waiting time, lower transplant rate, less living donor, more delayed graft function, and acute rejection. The conformity between vPRA and pPRA in HS was 75%, 57% between pPRA and aPRA. Forty-three percent (61/142) patients whose pPRA was >5% had no detectable aPRA and maintained similar outcomes as sensitized patients. Multivariate analysis showed consistently lower death-censored graft survival in HS defined by vPRA [HR 2.086 (95% CI 1.078-4.037), P < 0.05] and pPRA [HR 2.139 (95% CI 1.024-4.487), P < 0.05]. Both vPRA and pPRA provided reliable way estimating sensitization and predicting long-term graft survival, while aPRA might underestimate true sensitization. vPRA might be the most objective parameter to gauge sensitization.
虚拟群体反应性抗体（vPRA）已被用于评估全球范围内的致敏情况。目前尚不清楚它与长期预后如何关联，且其与峰值群体反应性抗体（pPRA）或实际群体反应性抗体（aPRA）的相关性尚未得到研究。我们回顾性分析了1996年1月1日至2011年7月31日期间在本中心接受单纯肾移植的18至65岁患者的数据。群体反应性抗体（PRA）通过固相技术计算得出。在726例合格病例中，无论PRA类型如何，致敏患者（PRA>5%）女性更多且有过移植史。高致敏患者（HS，PRA>50%）等待时间更长、移植率更低、活体供者更少、移植肾功能延迟恢复和急性排斥反应更多。HS患者中vPRA与pPRA的一致性为75%，pPRA与aPRA之间为57%。43%（61/142）的患者pPRA>5%但未检测到aPRA，其预后与致敏患者相似。多因素分析显示，由vPRA定义的HS患者死亡删失后的移植物存活率持续较低[风险比（HR）2.086（95%置信区间1.078 - 4.037），P<0.05]，pPRA定义的HS患者也是如此[HR 2.139（95%置信区间1.024 - 4.487），P<0.05]。vPRA和pPRA都为评估致敏情况和预测长期移植物存活提供了可靠方法，而aPRA可能会低估真正的致敏情况。vPRA可能是评估致敏情况最客观的参数。
