Cazarote Helena B, Shimakura Silvia, Valdameri Joana S, Contieri Fabiana L C, von Glehn Cristina Q C, Aita Carlos M, Susin Michelle F, Sotomaior Vanessa Santos, Glehn-Ponsirenas Renata
Transplant Immunology Laboratory, Hospital Universitário Cajuru, Curitiba, PR, Brazil; School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil.
Department of Statistics, Universidade Federal do Paraná, Curitiba, PR, Brazil.
Transpl Immunol. 2018 Aug;49:33-38. doi: 10.1016/j.trim.2018.03.002. Epub 2018 Mar 26.
Detection of donor-specific antibodies (DSA) has improved the risk classification and post-transplant evaluation of kidney recipients. Moreover, assessment of DSA C1q-binding ability has been shown to improve the individual risk classification of transplant patients for allograft loss, especially when detected after transplantation. The aim of this study was to evaluate the additional clinical impact of C1q-binding DSA detection in a population that was extensively monitored for DSA and MFI alterations. Forty-two kidney allograft recipients were followed-up at multiple time points for up to 5 years after transplantation for the presence of anti-HLA DSA-IgG total. The samples that were positive for these antibodies were retrospectively tested for the presence of complement-binding antibodies. Overall, 24 patients presented DSA, 29% (7) of which also produced complement-binding DSA. Compared to patients with non-C1q-binding DSA and non-sensitized patients, patients with C1q-binding DSA after transplantation had the lowest allograft survival rate at 5 years (p = 0.042) and showed a lower estimated glomerular filtration rate (based on the Modification of Diet in Renal Disease formula) during the post-transplant follow-up period (p = 0.01). Thus, post-transplant monitoring for complement-binding DSA is a useful tool for predicting individuals most at risk for allograft failure, and might also be beneficial for evaluation of immunosuppression regimens.
供体特异性抗体（DSA）的检测改善了肾移植受者的风险分类和移植后评估。此外，DSA与C1q结合能力的评估已被证明可改善移植患者发生移植物丢失的个体风险分类，尤其是在移植后检测到的时候。本研究的目的是评估在对DSA和平均荧光强度（MFI）改变进行广泛监测的人群中，检测与C1q结合的DSA的额外临床影响。42例肾移植受者在移植后长达5年的多个时间点进行随访，检测抗HLA DSA-IgG总量。对这些抗体呈阳性的样本进行回顾性检测，以确定是否存在补体结合抗体。总体而言，24例患者出现DSA，其中29%（7例）还产生补体结合DSA。与非C1q结合DSA的患者和未致敏患者相比，移植后出现C1q结合DSA的患者5年时的移植物存活率最低（p = 0.042），并且在移植后随访期间的估计肾小球滤过率（基于肾脏病饮食改良公式）较低（p = 0.01）。因此，移植后监测补体结合DSA是预测移植物失败风险最高个体的有用工具，也可能有助于评估免疫抑制方案。
