Nascimento E, Lucas-Junior F M, Fabreti-Oliveira R A, Vilela B, Tavora E R F, Silva J P L, Salomão-Filho A
Kidney Transplantation Center, Clinical Hospital, Belo Horizonte, Minas Gerais, Brazil; Institute of Medical Sciences, Faculty of Medical Sciences, Belo Horizonte, Minas Gerais, Brazil; IMUNOLAB-Laboratory of Histocompatibility and Immunogenetic, Belo Horizonte, Minas Gerais, Brazil.
Kidney Transplantation Center, Clinical Hospital, Belo Horizonte, Minas Gerais, Brazil.
Transplant Proc. 2016 Nov;48(9):3079-3084. doi: 10.1016/j.transproceed.2016.02.064.
In kidney transplantation, long-term graft survival has improved over the last few decades. Study to understand ultralong-term graft survival with graft functioning is rare, but a few researchers have tried to explain the factors involved in long-term graft survival. In this report, we explore the predictive factors that can be involved in ultralong-term graft survival.
Immunologic evaluations of the patients were performed using crossmatch (XM), serological, and high-resolution HLA typing for 8 loci. A transplant recipient was treated with azathioprine as immunosuppressive monotherapy for 42 years. Donor-specific antibodies (DSAs) were identified using panel reactive antibody single antigen beads (PRA-SAB) followed by EpVix and Matchmaker epitope analysis to define the immunogenic mismatch eplets.
The patient and donor were haploidentical for 7 loci and identical at the HLA-DPA1* locus. Among 61 identified eplet mismatches, DSAs were not detected against 59 eplets after 42 years of exposure to the patient's immune system with the exceptions of antibodies against the public eplets 9Y and 9YL from allele HLA-DPB1*03:01, and the transplanted kidney exhibited preserved structures.
The transplanted kidney has the preserved structure based on magnetic resonance imaging, the 2 DSAs were not deleterious to the graft until now, and the eplet mismatches were considered acceptable. The patient is in good clinical condition living with a 100-year-old graft, a serum creatinine level of 1.5 mg/dL, and an estimated glomerular filtration rate of 50 mL/1.72 m.
在肾移植领域，过去几十年中移植物的长期存活情况有所改善。关于理解超长期移植物存活及其功能的研究很少，但有一些研究人员试图解释影响长期移植物存活的因素。在本报告中，我们探讨了可能与超长期移植物存活相关的预测因素。
对患者进行免疫评估，采用交叉配型（XM）、血清学检测以及对8个位点进行高分辨率HLA分型。一名移植受者接受硫唑嘌呤作为免疫抑制单一疗法治疗达42年。使用群体反应性抗体单抗原珠（PRA-SAB）鉴定供者特异性抗体（DSA），随后进行EpVix和Matchmaker表位分析以确定免疫原性错配表位小体。
患者与供者在7个位点上为单倍型相同，并在HLA-DPA1位点上完全相同。在61个已鉴定的表位错配中，在患者免疫系统暴露42年后，除了针对来自等位基因HLA-DPB103:01的公共表位9Y和9YL的抗体外，未针对59个表位检测到DSA，且移植肾结构保持完整。
基于磁共振成像，移植肾结构保持完整，这2种DSA目前对移植物无害，且表位错配被认为是可接受的。该患者临床状况良好，拥有一个存活达100年的移植物，血清肌酐水平为1.5mg/dL，估计肾小球滤过率为50mL/1.72m² 。
