Tipjaiaue P, Ingsathit A, Kantachuvesiri P, Rattanasiri S, Thammanichanond D, Mongkolsuk T, Arpornsujaritkun N, Sumethkul V, Kantachuvesiri S
Division of Nephrology, Department of Medicine, Ramathibodi Hospital, Phyathai, Bangkok, Thailand.
Division of Nephrology, Department of Medicine, Ramathibodi Hospital, Phyathai, Bangkok, Thailand; Section for Clinical Epidemiology and Biostatistics, Ramathibodi Hospital, Phyathai, Bangkok, Thailand.
Transplant Proc. 2017 Jul-Aug;49(6):1249-1255. doi: 10.1016/j.transproceed.2017.02.059.
Sensitization is associated with a high rate of post-transplantation rejection. A desensitization protocol using therapeutic plasma exchange (TPE) was proposed to reduce anti-HLA antibody before transplantation, but there has been limited data regarding the efficacy of pretransplantation TPE in highly sensitized deceased-donor kidney transplantation (DDKT).
A retrospective cohort study of 142 patients who received DDKT was conducted and divided into two groups: a high-panel-reactive antibody (PRA) >50% group and a low-PRA ≤50% group. The high-PRA group was sub-divided into those who received and did not receive pretransplantation TPE. Donor-specific anti-HLA antibodies (DSA) were also collected pretransplantation in the high-PRA group.
The probability of acute rejection was 26, 4, and 9 cases/1000/person month in the high-PRA group with no TPE, the high-PRA group receiving TPE, and the low-PRA group, respectively (P = .0208). In the multivariable logistic regression analysis, the hazard ratio for graft rejection was 2.37 (95% confidence interval: 0.89 to 6.35) and 2.22 (95% confidence interval: 0.54 to 9.13) in the group of high-PRA who received TPE and high-PRA with no TPE, compared with the low-PRA group, respectively (P value not significant). The incidence of antibody-mediated rejection in 6 months in the DSA-positive subgroup was not different between those who received TPE or no TPE.
Desensitization with TPE is a reasonable alternative for highly sensitized DDKT. Patients who received pretransplantation TPE had a lower incidence of acute rejection compared to the group that did not receive TPE. However, pretransplantation TPE alone was not effective in the prevention of acute rejection in recipients with DSA.
致敏与移植后高排斥率相关。有人提出采用治疗性血浆置换（TPE）的脱敏方案来降低移植前的抗HLA抗体，但关于移植前TPE在高致敏尸体供肾移植（DDKT）中的疗效数据有限。
对142例接受DDKT的患者进行回顾性队列研究，分为两组：高群体反应性抗体（PRA）>50%组和低PRA≤50%组。高PRA组再细分为接受和未接受移植前TPE的患者。高PRA组在移植前也收集了供者特异性抗HLA抗体（DSA）。
高PRA组未进行TPE、接受TPE的高PRA组和低PRA组的急性排斥概率分别为26、4和9例/1000/人月（P = 0.0208）。在多变量逻辑回归分析中，与低PRA组相比，接受TPE的高PRA组和未接受TPE的高PRA组移植排斥的风险比分别为2.37（95%置信区间：0.89至6.35）和2.22（95%置信区间：0.54至9.13）（P值无统计学意义）。DSA阳性亚组中，接受TPE或未接受TPE的患者在6个月内抗体介导排斥的发生率无差异。
TPE脱敏是高致敏DDKT的合理替代方案。与未接受TPE的组相比，接受移植前TPE的患者急性排斥发生率较低。然而，单独的移植前TPE在预防DSA受体的急性排斥方面无效。
