Tinckam K J, Liwski R, Pochinco D, Mousseau M, Grattan A, Nickerson P, Campbell P
Division of Nephrology, Department of Medicine and HLA Laboratory, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Canadian Blood Services, Organ and Tissue Donation and Transplantation, Ottawa, Ontario, Canada.
Am J Transplant. 2015 Dec;15(12):3194-201. doi: 10.1111/ajt.13355. Epub 2015 Jun 16.
A calculated panel reactive antibody (cPRA) estimates the percentage of donors with unacceptable antigens (UA) for a recipient. cPRA may be underestimated in transplant candidates with UA to DQA, DPA, and DPB if these are not included in the calculation program. To serve the National Canadian Transplant Programs, a cPRA calculator was developed with complete molecular typing for all donors at HLA-A, B, C, DRB1, DRB3/4/5, DQA1, DQB1, DPA1, and DPB1, all resolved to serologic equivalents. The prevalence of UA at DQA, DPA and DPB was evaluated in a sensitized regional population. The impact of adding these additional UA to cPRA was calculated alone and in combination, and compared to the baseline cPRA for UA at A, B, C, DR, DR51/52/53, and DQ. Of 740 sensitized transplant candidates, 18% of total and 32% with cPRA≥95% had DQA UA. Twenty-seven percent of total and 54% with cPRA≥95% had DPB UA. Of 280/740 subjects with these UA, 36/280 (13%) had cPRA increase of >20% when they were included, 7% increased cPRA to ≥80% and 6% to ≥95%. Inclusion of DQA, DPA, and DPB UA in Canadian cPRA calculations improves the accuracy of cPRA where these are relevant in allocation.
计算得出的群体反应性抗体（cPRA）可估算出受体不可接受抗原（UA）的供体百分比。对于存在针对DQA、DPA和DPB的UA的移植候选者，如果这些抗原未包含在计算程序中，cPRA可能会被低估。为服务于加拿大全国移植项目，开发了一种cPRA计算器，对所有供体的HLA - A、B、C、DRB1、DRB3/4/5、DQA1、DQB1、DPA1和DPB1进行完整的分子分型，所有结果均转化为血清学等效值。在一个致敏的区域人群中评估了DQA、DPA和DPB处UA的流行率。单独及联合计算添加这些额外UA对cPRA的影响，并与A、B、C、DR、DR51/52/53和DQ处UA的基线cPRA进行比较。在740名致敏移植候选者中，总计18%且cPRA≥95%的患者存在DQA UA。总计27%且cPRA≥95%的患者存在DPB UA。在740名中有280名存在这些UA的受试者中，当纳入这些抗原时，280名中有36名（13%）的cPRA增加超过20%，7%的cPRA增加到≥80%，6%增加到≥95%。在加拿大cPRA计算中纳入DQA、DPA和DPB UA可提高cPRA在分配中相关情况下的准确性。
