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针对 HLA Ⅰ类分子的预先形成的供者特异性抗体对肾移植结局的影响：仅抗 Cw、抗 A 和/或抗 B 抗体的比较分析。

Impact of preformed donor-specific antibodies against HLA class I on kidney graft outcomes: Comparative analysis of exclusively anti-Cw anti-A and/or -B antibodies.

作者信息

Santos Sofia, Malheiro Jorge, Tafulo Sandra, Dias Leonídio, Carmo Rute, Sampaio Susana, Costa Marta, Campos Andreia, Pedroso Sofia, Almeida Manuela, Martins La Salete, Henriques Castro, Cabrita António

机构信息

Sofia Santos, Jorge Malheiro, Leonídio Dias, Marta Costa, Andreia Campos, Sofia Pedroso, Manuela Almeida, La Salete Martins, Castro Henriques, António Cabrita, Department of Nephrology and Kidney Transplantation, Centro Hospitalar do Porto, 4099-001 Porto, Portugal.

出版信息

World J Transplant. 2016 Dec 24;6(4):689-696. doi: 10.5500/wjt.v6.i4.689.

DOI:10.5500/wjt.v6.i4.689
PMID:28058219
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5175227/
Abstract

AIM

To analyze the clinical impact of preformed antiHLA-Cw antiHLA-A and/or -B donor-specific antibodies (DSA) in kidney transplantation.

METHODS

Retrospective study, comparing 12 patients transplanted with DSA exclusively antiHLA-Cw with 23 patients with preformed DSA antiHLA-A and/or B.

RESULTS

One year after transplantation there were no differences in terms of acute rejection between the two groups (3 and 6 cases, respectively in the DSA-Cw and the DSA-A-B groups; = 1). At one year, eGFR was not significantly different between groups (median 59 mL/min in DSA-Cw group, compared to median 51 mL/min in DSA-A-B group, = 0.192). Moreover, kidney graft survival was similar between groups at 5-years (100% in DSA-Cw group 91% in DSA-A-B group, = 0.528). The sole independent predictor of antibody mediated rejection (AMR) incidence was DSA strength (HR = 1.07 per 1000 increase in MFI, = 0.034). AMR was associated with shortened graft survival at 5-years, with 75% and 100% grafts surviving in patients with or without AMR, respectively (Log-rank = 0.005).

CONCLUSION

Our data indicate that DSA-Cw are associated with an identical risk of AMR and impact on graft function in comparison with "classical" class I DSA.

摘要

目的

分析预先形成的抗HLA-Cw、抗HLA-A和/或 -B供者特异性抗体（DSA）在肾移植中的临床影响。

方法

回顾性研究，比较12例仅移植有抗HLA-Cw DSA的患者与23例预先形成抗HLA-A和/或B DSA的患者。

结果

移植后1年，两组在急性排斥反应方面无差异（DSA-Cw组和DSA-A-B组分别为3例和6例；P = 1）。1年时，两组间的估算肾小球滤过率（eGFR）无显著差异（DSA-Cw组中位数为59 mL/分钟，DSA-A-B组中位数为51 mL/分钟，P = 0.192）。此外，两组间5年时的肾移植存活率相似（DSA-Cw组为100%，DSA-A-B组为91%，P = 0.528）。抗体介导排斥反应（AMR）发生率的唯一独立预测因素是DSA强度（平均荧光强度（MFI）每增加1000，风险比（HR）= 1.07，P = 0.034）。AMR与5年时移植肾存活时间缩短相关，有或无AMR的患者中移植肾存活率分别为75%和100%（对数秩检验P = 0.005）。

结论

我们的数据表明，与“经典”的I类DSA相比，抗HLA-Cw DSA发生AMR的风险相同，且对移植肾功能的影响也相同。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/38c1/5175227/462e572ec6c4/WJT-6-689-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/38c1/5175227/6c81c5643327/WJT-6-689-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/38c1/5175227/30970a57b728/WJT-6-689-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/38c1/5175227/fe58e91fcc4d/WJT-6-689-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/38c1/5175227/cbe008c57b3f/WJT-6-689-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/38c1/5175227/462e572ec6c4/WJT-6-689-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/38c1/5175227/6c81c5643327/WJT-6-689-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/38c1/5175227/30970a57b728/WJT-6-689-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/38c1/5175227/fe58e91fcc4d/WJT-6-689-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/38c1/5175227/cbe008c57b3f/WJT-6-689-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/38c1/5175227/462e572ec6c4/WJT-6-689-g005.jpg

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