Rusai Krisztina, Dworak Johanna, Potemkina Alexandra, Fischer Gottfried, Csaicsich Dagmar, Arbeiter Klaus, Aufricht Christoph, Müller-Sacherer Thomas
Department of Paediatrics and Adolescent Medicine, Medical University Vienna, Austria, Vienna, Austria.
University Clinic for Blood Group Serology and Transfusion Medicine, Medical University Vienna, Austria, Vienna, Austria.
Pediatr Transplant. 2016 Jun;20(4):507-14. doi: 10.1111/petr.12707. Epub 2016 Apr 19.
In the pediatric population, little is known on de novo DSA development, its impact on graft function, and association with suboptimal IS. We assessed the prevalence of de novo DSA in the Vienna cohort of 40 renal transplanted children and adolescents and prospectively followed its association with clinical parameters, graft function, and proteinuria for one yr. At the cross-sectional analysis (median post-transplant time of five yr), 17% of the patients had developed de novo DSA. All HLA-Ab were anti-HLA class II antibodies and persisted in 85% of the cases until the follow-up screening performed within one yr. Basic clinical and laboratory parameters did not differ between DSA-negative and DSA-positive patients at the time of HLA-Ab screening. Suboptimal IS due to reduced medication or non-adherence could not be proven in DSA-positive patients. The changes in eGFR did not differ during the prospective study period, but there was a significantly higher proteinuria in the DSA-positive patients during the follow-up. Our data demonstrate an overall prevalence of 17% of de novo DSA in a pediatric renal transplant cohort. During 12 months of prospective follow-up time, we could demonstrate a significant impact of de novo DSA presence on proteinuria.
在儿科人群中，对于新发供者特异性抗体（DSA）的产生、其对移植肾功能的影响以及与免疫抑制不充分（IS）的关联了解甚少。我们评估了维也纳队列中40例接受肾移植的儿童和青少年新发DSA的患病率，并前瞻性地随访其与临床参数、移植肾功能及蛋白尿的关联，为期1年。在横断面分析（移植后中位时间为5年）时，17%的患者出现了新发DSA。所有HLA抗体均为抗HLA II类抗体，85%的病例中这些抗体持续存在，直至在1年内进行的随访筛查。在HLA抗体筛查时，DSA阴性和DSA阳性患者的基本临床和实验室参数并无差异。在DSA阳性患者中，未证实存在因药物减量或不依从导致的免疫抑制不充分情况。在前瞻性研究期间，估算肾小球滤过率（eGFR）的变化并无差异，但在随访期间，DSA阳性患者的蛋白尿显著更高。我们的数据表明，在儿科肾移植队列中，新发DSA的总体患病率为17%。在12个月的前瞻性随访期内，我们证实了新发DSA的存在对蛋白尿有显著影响。
