Monfá Elena, San Segundo David, San Millán Juan Carlos Ruiz, Sanabria Judith, Albines Zoila, Rodrigo Emilio, Romón Iñigo, Asensio Esther, Arias Manuel, López-Hoyos Marcos
Nephrology Department, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain.
Immunology Department, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain; Histocompatibility Testing Laboratory, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
Nefrologia. 2017 Jul-Aug;37(4):415-422. doi: 10.1016/j.nefro.2017.02.002. Epub 2017 Mar 19.
Steroid withdrawal in renal transplantation is desirable to avoid their adverse effects. However, by decreasing the immunosuppression, could lead to an increased risk for the development of HLA-Abs.
Evaluate the relationship between steroid withdrawal and development of HLA-Abs in renal transplantation.
We analyzed sera by Luminex from 182 kidney transplants performed from 1998 to 2011, before and two years after transplantation. All the patients had a pretransplant PRA (panel reactive of antibodies) <20% by complement-dependent cytotoxicity (CDC) and maintenance immunosuppression with tacrolimus and mycophenolate mofetil (MMF). We compared a group of steroid withdrawal at 7 months (group-I; n=130) and another control with non-withdrawal (group-II; n=52).
22 patients (16.9%) in group-I and 11 patients in group-II (21.1%) had HLA-Abs after two years (pNS). Despite excluding patients with PRA >20%, we detected HLA-Abs pretransplant by Luminex in 11.5% of patients in both groups, of which, 66.6%, versus 53% (p 0.058), developed new specificities, with a similar percentage of donor specific antibodies (DSA) in both groups (33.33% vs 36.36%), pNS. In the subgroup without pretransplant HLA-Abs (group-I; n=115, group-II; n=45), 6.08% developed de novo HLA-Abs, being DSA 3.4% (Group-I) versus 7.69% in group II with 3.84% DSA (pNS).
Steroid withdrawal at 7 months of renal transplantation does not entail a higher risk in terms of HLA-Abs development in patients without pretransplant HLA-Abs and treatment with tacrolimus and MMF, although larger studies are needed to confirm these findings.
肾移植中停用类固醇药物是为了避免其不良反应。然而，通过降低免疫抑制作用，可能会增加HLA抗体产生的风险。
评估肾移植中类固醇药物停用与HLA抗体产生之间的关系。
我们采用Luminex技术分析了1998年至2011年间进行的182例肾移植患者在移植前及移植后两年的血清。所有患者移植前通过补体依赖细胞毒性试验（CDC）检测的群体反应性抗体（PRA）<20%，并使用他克莫司和霉酚酸酯（MMF）进行维持免疫抑制治疗。我们比较了一组在7个月时停用类固醇药物的患者（第一组；n = 130）和另一组未停用类固醇药物的对照患者（第二组；n = 52）。
两年后，第一组中有22例患者（16.9%）产生了HLA抗体，第二组中有11例患者（21.1%）产生了HLA抗体（p无统计学意义）。尽管排除了PRA>20%的患者，但我们通过Luminex技术在两组中均检测到11.5%的患者在移植前就存在HLA抗体，其中，66.6%的患者产生了新的特异性抗体，而另一组为53%（p = 0.058），两组中供体特异性抗体（DSA）的比例相似（33.33%对36.36%），p无统计学意义。在移植前无HLA抗体的亚组中（第一组；n = 115，第二组；n = 45），6.08%的患者产生了新发HLA抗体，其中DSA在第一组为3.4%，而第二组为7.69%，DSA为3.84%（p无统计学意义）。
对于移植前无HLA抗体且接受他克莫司和MMF治疗的肾移植患者，在移植7个月时停用类固醇药物并不会增加HLA抗体产生的风险，尽管需要更大规模的研究来证实这些发现。
