Kauke Teresa, Klimaschewski Sandra, Schoenermarck Ulf, Fischereder Michael, Dick Andrea, Guba Markus, Stangl Manfred, Werner Jens, Meiser Bruno, Habicht Antje
Laboratory for Immunogenetics, University Hospital LMU, Munich, Germany.
Clinic for General, Visceral-, Transplantation-, Vascular- and Thoracic Surgery, University Hospital LMU, Munich, Germany.
PLoS One. 2016 Jan 5;11(1):e0146075. doi: 10.1371/journal.pone.0146075. eCollection 2016.
The shortage of deceased donors led to an increase of living donor kidney (LDK) transplantations performed in the presence of donor-specific antibodies (DSA) or ABO incompatibility (ABOi) using various desensitization protocols.
We herein analyzed 26 ABOi and 8 Luminex positive DSA patients who were successfully desensitized by anti-CD20, antigen-specific immunoadsorption and/or plasmapheresis to receive an LDK transplant. Twenty LDK recipients with non-donor-specific HLA-antibodies (low risk) and 32 without anti-HLA antibodies (no risk) served as control groups.
1-year graft survival rate and renal function was similar in all 4 groups (creatinine: 1.63 ± 0.5 vs 1.78 ± 0.6 vs 1.64 ± 0.5 vs 1.6 ± 0.3 mg/dl in ABOi, DSA, low risk and no risk group). The incidence of acute T-cell mediated rejections did not differ between the 4 groups (15% vs 12, 5% vs 15% vs 22% in ABOi, DSA, low risk and no risk), while antibody-mediated rejections were only found in the DSA (25%) and ABOi (7.5%) groups. Incidence of BK nephropathy (BKVN) was significantly more frequent after desensitization as compared to controls (5/34 vs 0/52, p = 0.03).
We demonstrate favorable short-term allograft outcome in LDK transplant recipients after desensitization. However, the desensitization was associated with an increased risk of BKVN.
已故供体的短缺导致在存在供体特异性抗体（DSA）或ABO血型不相容（ABOi）的情况下，使用各种脱敏方案进行的活体供肾（LDK）移植数量增加。
我们在此分析了26例ABOi患者和8例Luminex检测DSA阳性的患者，他们通过抗CD20、抗原特异性免疫吸附和/或血浆置换成功脱敏，接受了LDK移植。20例具有非供体特异性HLA抗体（低风险）的LDK受者和32例无抗HLA抗体（无风险）的受者作为对照组。
所有4组的1年移植肾存活率和肾功能相似（ABOi组、DSA组、低风险组和无风险组的肌酐水平分别为1.63±0.5、1.78±0.6、1.64±0.5和1.6±0.3mg/dl）。4组之间急性T细胞介导的排斥反应发生率无差异（ABOi组、DSA组、低风险组和无风险组分别为15%、12.5%、15%和22%），而抗体介导的排斥反应仅在DSA组（25%）和ABOi组（7.5%）中发现。与对照组相比，脱敏后BK肾病（BKVN）的发生率明显更高（5/34 vs 0/52，p=0.03）。
我们证明了脱敏后LDK移植受者短期移植物预后良好。然而，脱敏与BKVN风险增加有关。
