Gil Beatriz Chamun, Kulzer Adriane Stefani Silva, de Moraes Priscila, Toresan Realdete, da Rosa Vicari Alessandra, Dos Santos Fagundes Iara, Merzoni Jóice, Ewald Gisele Menezes, Cardone Jacqueline Moraes, Silva Fernanda Gamio, Manfro Roberto Ceratti, Jobim Luiz Fernando
Service of Immunology, Hospital de Clínicas de Porto Alegre, Brazil; Graduate Program in Medicine: Surgical Sciences, UFRGS, Brazil.
Service of Immunology, Hospital de Clínicas de Porto Alegre, Brazil.
Transpl Immunol. 2018 Aug;49:7-11. doi: 10.1016/j.trim.2018.03.006. Epub 2018 Mar 22.
Preformed anti-human leukocyte antigen (HLA) antibodies may be present in the blood of kidney transplant candidates. The production of these antibodies may occur in the post-transplant period, with the possible development of donor-specific antibodies (DSA). Luminex-based tests, such as the single antigen (SA) assay and the Luminex crossmatch (Xm-DSA) assay are the most commonly used tools to detect anti-HLA antibodies, due to their high sensitivity and specificity. This cross-sectional study aimed to compare the findings of two methods for the detection of DSAs after kidney transplant: SA and Xm-DSA. A total of 122 patients who underwent deceased donor kidney transplant at Hospital de Clínicas de Porto Alegre were included. The SA assay detected anti-class I HLA DSAs in 17 patients (13.9%) and anti-class II HLA DSAs in 22 patients (19.6%), whereas the Xm-DSA detected DSAs in 18 patients (14.8%) both against class I and class II antigens. There was agreement between the two methods for class I (kappa = 0.66, p = 0.001) and class II (kappa = 0.54, p = 0.025) antigens. The incidence of DSAs as obtained by the SA assay was 15.57%, and the most prevalent DSAs were those against HLA-DR antigens. Patient survival at 3 years was 92%. The two techniques assessed in this study provide important information on the presence of DSAs and may help in the post-transplant patient monitoring and in immunosuppressive strategy.
肾移植候选者的血液中可能存在预先形成的抗人类白细胞抗原（HLA）抗体。这些抗体可能在移植后产生，并有可能发展为供体特异性抗体（DSA）。基于Luminex的检测方法，如单抗原（SA）检测和Luminex交叉配型（Xm-DSA）检测，因其高灵敏度和特异性，是检测抗HLA抗体最常用的工具。这项横断面研究旨在比较肾移植后两种检测DSA的方法：SA和Xm-DSA。共有122例在阿雷格里港临床医院接受尸体供肾移植的患者纳入研究。SA检测在17例患者（13.9%）中检测到抗I类HLA DSA，在22例患者（19.6%）中检测到抗II类HLA DSA，而Xm-DSA在18例患者（14.8%）中检测到针对I类和II类抗原的DSA。两种方法在I类抗原（kappa = 0.66，p = 0.001）和II类抗原（kappa = 0.54，p = 0.025）方面存在一致性。SA检测获得的DSA发生率为15.57%，最常见的DSA是针对HLA-DR抗原的抗体。3年时患者生存率为92%。本研究评估的两种技术提供了有关DSA存在的重要信息，并可能有助于移植后患者监测和免疫抑制策略的制定。
