Kausman Joshua Y, Walker Amanda M, Cantwell Linda S, Quinlan Catherine, Sypek Matthew P, Ierino Francesco L
Department of Nephrology, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.
Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.
Pediatr Transplant. 2016 Nov;20(7):931-938. doi: 10.1111/petr.12815. Epub 2016 Sep 24.
Donor-recipient HLA mismatch remains a leading cause for sensitization and graft loss in kidney transplantation. HLA compatibility at an epitope level is emerging as an improved method of matching compared with current HLA antigen allocation. A novel epitope-based allocation approach to prospectively exclude donors with high-level mismatches was implemented for pediatric KTRs on the DD waiting list. Nineteen consecutive transplants were followed for 12 months, including eight DD KTRs listed with eplet exclusions, as well as three DD KTRs and eight LD KTRs without exclusions. KTRs with eplet exclusions had estimated GFR of 78.5 mL/min/1.73 m , no episodes of rejection, and time to transplant 6.55 months. HLA-A, HLA-B, HLA-DR antigen mismatches were similar between all groups. KTRs with exclusions had significantly lower class II eplet mismatches (20.4) than the contemporary DD KTRs without exclusions (63.7) and DD KTRs transplanted in the preceding decade (46.9). dnDSAs were identified in two of eight DD KTRs with exclusions, two of three DD KTRs without exclusions and five of eight LD KTRs. Epitope-based allocation achieved timely access to transplantation, low class II eplet mismatches, and low rates of dnDSAs in the first year. This strategy requires longer follow-up and larger numbers, but has the potential to reduce anti-HLA sensitization and improve both graft survival and opportunities for future retransplantation.
供受者 HLA 错配仍然是肾移植中致敏和移植物丢失的主要原因。与当前的 HLA 抗原分配相比，表位水平的 HLA 相容性正在成为一种改进的配型方法。一种基于表位的新型分配方法被用于前瞻性地排除等待名单上儿科肾移植受者（KTRs）中高水平错配的供者。对 19 例连续移植患者进行了 12 个月的随访，包括 8 例通过表位排除列出的死体供肾 KTRs，以及 3 例未排除的死体供肾 KTRs 和 8 例活体供肾 KTRs。通过表位排除的 KTRs 的估计肾小球滤过率为 78.5 mL/min/1.73 m²，无排斥反应发生，移植时间为 6.55 个月。所有组之间 HLA - A、HLA - B、HLA - DR 抗原错配情况相似。与未排除的当代死体供肾 KTRs（63.7）和前十年移植的死体供肾 KTRs（46.9）相比，通过排除的 KTRs 的 II 类表位错配显著更低（20.4）。在 8 例通过排除的死体供肾 KTRs 中有 2 例、3 例未排除的死体供肾 KTRs 中有 2 例以及 8 例活体供肾 KTRs 中有 5 例检测到供者特异性抗体（dnDSAs）。基于表位的分配在第一年实现了及时的移植机会、低 II 类表位错配以及低 dnDSA 发生率。这种策略需要更长时间的随访和更大的样本量，但有可能降低抗 HLA 致敏，提高移植物存活率以及未来再次移植的机会。
