Vimal M, Chacko M P, Basu G, Daniel D
Department of Pathology, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, Tamil Nadu, India.
Department of Transfusion Medicine and Immunohaematology, Christian Medical College, Vellore, Tamil Nadu, India.
Indian J Nephrol. 2017 Sep-Oct;27(5):347-352. doi: 10.4103/ijn.IJN_132_16.
The significance of pretransplant anti-human leukocyte antigen antibody levels that are detectable by more sensitive platforms (including the Luminex platform) yet undetected by complement-dependent cytotoxicity (CDC) assay remains unclear. The aim of this study was to determine the clinical significance of the donor-specific antibody (DSA) assay Luminex crossmatch and its impact on short-term renal graft outcome such as acute rejections, graft survival, and graft function. The results of pretransplant DSA-lymphocyte crossmatching (LCXM) assay in 126 renal allograft recipients whose CDCs crossmatches were negative were retrospectively analyzed for correlation with posttransplant outcomes. Of the 126 recipients, 32 (25.4%) had pretransplant DSA positive. Statistically significant association was found between DSA-LCXM positivity with 14 day estimated glomerular filtration rate (eGFR) ( = 0.05), DSA Class I with 3 ( = 0.014) and 6 month ( = 0.02) eGFR, DSA Class II with 14 day ( = 0.06) and 1 month ( = 0.10) eGFR, mean fluorescent intensity (MFI) DSA with 7 day ( = 0.08) and 14 day ( = 0.09) eGFR, and maximum MFI DSA with 7 day eGFR ( = 0.09). The posttransplant eGFR was higher at various time intervals in DSA-LCXM-negative patients as compared to DSA-positive patients. However, pretransplant DSA-LCXM results did not predict the rejection episodes, graft loss, and 1-year posttransplant 24 h urine protein. Pretransplant DSA detected by LCXM in patients with a negative CDC does not predict adverse short-term outcomes. However, the difference in posttransplant eGFR supports further investigation in long-term effects.
通过更灵敏平台（包括Luminex平台）可检测到但补体依赖细胞毒性（CDC）检测未检测到的移植前抗人白细胞抗原抗体水平的意义仍不明确。本研究的目的是确定供者特异性抗体（DSA）检测Luminex交叉配型的临床意义及其对短期肾移植结局的影响，如急性排斥反应、移植肾存活和移植肾功能。回顾性分析126例肾移植受者移植前DSA淋巴细胞交叉配型（LCXM）检测结果，这些受者的CDC交叉配型为阴性，分析其与移植后结局的相关性。126例受者中，32例（25.4%）移植前DSA阳性。发现DSA-LCXM阳性与14天估计肾小球滤过率（eGFR）（P = 0.05）、DSA I类与3个月（P = 0.014）和6个月（P = 0.02）eGFR、DSA II类与14天（P = 0.06）和1个月（P = 0.10）eGFR、平均荧光强度（MFI）DSA与7天（P = 0.08）和14天（P = 0.09）eGFR以及最大MFI DSA与7天eGFR（P = 0.09）之间存在统计学显著关联。与DSA阳性患者相比，DSA-LCXM阴性患者在不同时间间隔的移植后eGFR更高。然而，移植前DSA-LCXM结果不能预测排斥反应发作、移植肾丢失和移植后一年2期4小时尿蛋白。LCXM检测出的移植前DSA在CDC阴性患者中不能预测不良短期结局。然而，移植后eGFR的差异支持对长期影响进行进一步研究。
