Akgul S U, Ciftci H S, Temurhan S, Caliskan Y, Bayraktar A, Tefik T, Kaya I A, Canitez I O, Demir E, Yazici H, Bakkaloglu H, Aydin A E, Turkmen A, Nane I, Aydin F, Oguz F S
Department of Medical Biology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
Department of Medical Biology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
Transplant Proc. 2017 Apr;49(3):425-429. doi: 10.1016/j.transproceed.2017.02.004.
Human leukocyte antigen (HLA) allo-immunization is caused by various events such as blood transfusions, pregnancies, or organ transplantations, which can lead to sensitization. In this retrospective study, we evaluated different sensitization models and their effects on panel-reactive antibody (PRA) profiles of renal transplantation candidates.
Anti-HLA class I/II antibody screening tests were performed in 906 renal transplantation candidates with the use of a microbead-based assay (Luminex).
Two hundred ninety-seven (32.8%) of the patients were determined as positive in terms of PRA, and 609 (67.2%) were negative. Sensitized and non-sensitized patients were compared separately in terms of each sensitization type. The anti-HLA class I, II, and I+II positivity rates in patients sensitized only by blood transfusion were 13.1%, 6.3%, and 14.1%, the rates with pregnancy sensitization were 35.5%, 29%, and 45.2%, and rates with previous transplantation sensitization were 15.6%, 34.4%, and 38.9%, respectively. Prevalence of PRA positivity was significantly higher in patients with previous pregnancy than with transplantation and transfusion (odds ratio, 1.003; 95% confidence interval, 0.441-2.281; P = .031). The risk of developing HLA class I antibodies was higher in pregnancies (P < .001), and the risk of developing anti-HLA class II antibodies was higher in patients who had undergone a previous transplantation (P < .001). The rate of developing HLA-B antibodies in patients sensitized by pregnancy were significantly higher compared with sensitization after transfusion (P = .015), as was the rate of developing HLA-DQ antibodies in patients sensitized by previous transplantation compared with sensitization through pregnancy (P = .042).
In patients who are waiting for kidney transplantation, sensitization by pregnancy and transplantation have a significant impact on development of HLA class I and class II antibodies.
人类白细胞抗原（HLA）同种免疫是由输血、妊娠或器官移植等多种事件引起的，这些事件可导致致敏。在这项回顾性研究中，我们评估了不同的致敏模型及其对肾移植候选者群体反应性抗体（PRA）谱的影响。
使用基于微珠的检测方法（Luminex）对906名肾移植候选者进行了抗HLA I/II类抗体筛查试验。
297名（32.8%）患者的PRA检测呈阳性，609名（67.2%）呈阴性。分别根据每种致敏类型对致敏和未致敏患者进行比较。仅因输血致敏的患者中，抗HLA I类、II类和I+II类阳性率分别为13.1%、6.3%和14.1%；因妊娠致敏的患者中，阳性率分别为35.5%、29%和45.2%；既往有移植致敏史的患者中，阳性率分别为15.6%、34.4%和38.9%。既往妊娠患者的PRA阳性率显著高于移植和输血患者（优势比，1.003；95%置信区间，0.441-2.281；P = 0.031）。妊娠患者产生HLA I类抗体的风险更高（P < 0.001），既往接受过移植的患者产生抗HLA II类抗体的风险更高（P < 0.001）。与输血致敏相比，妊娠致敏患者产生HLA-B抗体的比率显著更高（P = 0.015），与妊娠致敏相比，既往移植致敏患者产生HLA-DQ抗体的比率也更高（P = 0.042）。
在等待肾移植的患者中，妊娠和移植致敏对HLA I类和II类抗体的产生有显著影响。
