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抗体不相容肾移植中供体HLA特异性IgG的亚类分析显示,IgG4与排斥反应和移植失败存在显著关联。

Subclass analysis of donor HLA-specific IgG in antibody-incompatible renal transplantation reveals a significant association of IgG4 with rejection and graft failure.

作者信息

Khovanova Natasha, Daga Sunil, Shaikhina Torgyn, Krishnan Nithya, Jones James, Zehnder Daniel, Mitchell Daniel, Higgins Robert, Briggs David, Lowe David

机构信息

School of Engineering, University of Warwick, Coventry, UK.

Clinical Sciences Research Laboratories, University of Warwick, Coventry, UK.

出版信息

Transpl Int. 2015 Dec;28(12):1405-15. doi: 10.1111/tri.12648. Epub 2015 Sep 1.

Abstract

Donor HLA-specific antibodies (DSAs) can cause rejection and graft loss after renal transplantation, but their levels measured by the current assays are not fully predictive of outcomes. We investigated whether IgG subclasses of DSA were associated with early rejection and graft failure. DSA levels were determined pretreatment, at the day of peak pan-IgG level and at 30 days post-transplantation in eighty HLA antibody-incompatible kidney transplant recipients using a modified microbead assay. Pretreatment IgG4 levels were predictive of acute antibody-mediated rejection (P = 0.003) in the first 30 days post-transplant. Pre-treatment presence of IgG4 DSA (P = 0.008) and day 30 IgG3 DSA (P = 0.03) was associated with poor graft survival. Multivariate regression analysis showed that in addition to pan-IgG levels, total IgG4 levels were an independent risk factor for early rejection when measured pretreatment, and the presence of pretreatment IgG4 DSA was also an independent risk factor for graft failure. Pretreatment IgG4 DSA levels correlated independently with higher risk of early rejection episodes and medium-term death-censored graft survival. Thus, pretreatment IgG4 DSA may be used as a biomarker to predict and risk stratify cases with higher levels of pan-IgG DSA in HLA antibody-incompatible transplantation. Further investigations are needed to confirm our results.

摘要

供体HLA特异性抗体(DSA)可导致肾移植后发生排斥反应和移植物丢失,但目前检测方法所测得的其水平并不能完全预测预后。我们研究了DSA的IgG亚类是否与早期排斥反应和移植物衰竭相关。使用改良微珠分析法,在80例HLA抗体不相容肾移植受者移植前、泛IgG水平峰值日及移植后30天测定DSA水平。移植后前30天,移植前IgG4水平可预测急性抗体介导的排斥反应(P = 0.003)。移植前存在IgG4 DSA(P = 0.008)和移植后30天IgG3 DSA(P = 0.03)与移植物存活率低相关。多变量回归分析表明,除了泛IgG水平外,移植前测定的总IgG4水平是早期排斥反应的独立危险因素,移植前存在IgG4 DSA也是移植物衰竭的独立危险因素。移植前IgG4 DSA水平与早期排斥反应发作风险较高和中期死亡截尾移植物存活率独立相关。因此,移植前IgG4 DSA可作为一种生物标志物,用于预测和对HLA抗体不相容移植中泛IgG DSA水平较高的病例进行风险分层。需要进一步研究来证实我们的结果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d2ca/4975692/1b6ceb1587a3/TRI-28-1405-g001.jpg

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