Tokodai K, Kawagishi N, Miyagi S, Nakanishi C, Hara Y, Fujio A, Kashiwadate T, Maida K, Goto H, Kamei T, Ohuchi N
Department of Advanced Surgical Science and Technology, Tohoku University, Sendai, Japan.
Department of Advanced Surgical Science and Technology, Tohoku University, Sendai, Japan.
Transplant Proc. 2016 May;48(4):1139-41. doi: 10.1016/j.transproceed.2015.12.081.
Post-transplant donor-specific anti-HLA antibodies (DSA) reportedly have detrimental effects on the outcomes of organ transplantation. However, the prevalence of post-transplant DSA in the long term after pediatric liver transplantation remains unclear, and the significance of post-transplant DSA is unknown. The aim of this cross-sectional study was to determine the prevalence of and characteristics of patients with post-transplant DSA.
Of the 84 pediatric liver transplant recipients who were followed up in the outpatient department of our institution, 34 patients with available HLA typing data were included after they or their parent(s) provided informed consent for DSA evaluations. Luminex single-antigen bead assays were performed, and a mean fluorescence intensity of ≥1000 was used as the cut-off for a positive reaction.
No class I DSA were detected, whereas class II DSA were detected in 11 patients (32%). There were no differences in age at transplantation, immunosuppressive drugs, or follow-up period between the DSA-positive and DSA-negative patients. The rate of positive pre-transplant complement-dependent cytotoxicity crossmatch was higher with class II DSA than without, although the difference was not statistically significant.
The utility of screening for class I DSA was insignificant in the long-term follow-up of pediatric liver transplant recipients. The prevalence of class II DSA was relatively high; therefore, screening for class II DSA might be justified, although a follow-up survey of the association between post-transplant class II DSA and the long-term clinical course needs to be conducted.
据报道，移植后供体特异性抗人白细胞抗原抗体（DSA）对器官移植的预后有不利影响。然而，小儿肝移植术后长期DSA的发生率仍不清楚，且移植后DSA的意义尚不明确。本横断面研究的目的是确定移植后DSA患者的发生率及特征。
在我院门诊随访的84例小儿肝移植受者中，34例有可用的HLA分型数据，在其本人或其父母签署DSA评估知情同意书后纳入研究。采用Luminex单抗原微珠分析法，以平均荧光强度≥1000作为阳性反应的截断值。
未检测到I类DSA，而在11例患者（32%）中检测到II类DSA。DSA阳性和DSA阴性患者在移植年龄、免疫抑制药物或随访时间方面无差异。II类DSA患者移植前补体依赖细胞毒交叉配型阳性率高于无II类DSA患者，尽管差异无统计学意义。
在小儿肝移植受者的长期随访中，筛查I类DSA的作用不大。II类DSA的发生率相对较高；因此，筛查II类DSA可能是合理的，尽管需要对移植后II类DSA与长期临床病程之间的关联进行随访调查。
