Omrani Osama, Alawwami Moheeb, Buraiki Jehad, Selimovic Nedim
Nedim Selimovic, Department of Cardiology, Angereds Narsjukhus,, SE-424 Angered, Sweden,
Ann Saudi Med. 2018 Mar-Apr;38(2):97-104. doi: 10.5144/0256-4947.2018.97.
HLA-DQ donor-specific antibodies (DSA) are implicated in allograft dysfunction after renal and lung transplantation. Limited data exists on the impact of HLA-DQ antibodies on heart transplant patients.
To investigate the impact of DSA formation on allograft function and outcomes in heart transplant patients.
Retrospective cohort study.
Collating post-transplantation patient data from computerized database in a tertiary hospital in Riyadh, Saudi Arabia from January 2006 to October 2014.
We excluded recipients with positive preoperative complement-dependent-cytotoxicity crossmatch grafts and those with preformed DSA. Anti-HLA antibodies were identified using Luminex-based assay in sera collected before transplantation with a routine endomyocardial biopsy the first year and then annually.
Primary outcome measures were all-cause mortality, development of antibody mediated rejection, treated acute cellular rejection (ACR) and cardiac allograft vasculopathy (CAV).
127 patients.
DSA formation occurred in 43/127 (34%), with 33/43 (77%) targeting HLA-DQ antigens alone (n=7) or in combination with -DR, -A or B antibodies (n=26). Most (76%) were male and the mean (SD) age was 36 (14) years. Ten patients developed -A, -B or -DR antibodies without -DQ antibodies also present. Treated ACR (P=.011), reduced left ventricular ejection fraction (P less than .001), CAV development (P=.003), and all-cause mortality (P=.01) were all significantly more prevalent in the DSA-positive cohort.
HLA-DQ donor-specific antibodies were the most common type detected and may play a significant role in poor outcomes post-cardiac transplantation. This emphasizes the importance of HLA-DQ matching and monitoring for DSA formation in order to minimize post-transplantation immunological risk.
Retrospective design comes with inherent biases, results from single institute, with a particularly young cohort.
None.
HLA - DQ供者特异性抗体（DSA）与肾移植和肺移植后的移植物功能障碍有关。关于HLA - DQ抗体对心脏移植患者影响的数据有限。
研究DSA形成对心脏移植患者移植物功能和预后的影响。
回顾性队列研究。
整理2006年1月至2014年10月沙特阿拉伯利雅得一家三级医院计算机数据库中的移植后患者数据。
我们排除了术前补体依赖细胞毒性交叉配型阳性的受者以及那些预先存在DSA的受者。在移植前采集的血清中使用基于Luminex的检测方法鉴定抗HLA抗体，第一年进行常规心内膜心肌活检，之后每年进行一次。
主要观察指标为全因死亡率、抗体介导排斥反应的发生、治疗的急性细胞排斥反应（ACR）和心脏移植物血管病变（CAV）。
127例患者。
43/127（34%）发生了DSA形成，其中33/43（77%）仅针对HLA - DQ抗原（n = 7）或与 - DR、- A或B抗体联合（n = 26）。大多数（76%）为男性，平均（标准差）年龄为36（14）岁。10例患者产生了 - A、- B或 - DR抗体，但不存在 - DQ抗体。在DSA阳性队列中，治疗的ACR（P = 0.011）、左心室射血分数降低（P < 0.001）、CAV发生（P = 0.003）和全因死亡率（P = 0.01）均显著更常见。
HLA - DQ供者特异性抗体是检测到的最常见类型，可能在心脏移植后不良预后中起重要作用。这强调了HLA - DQ配型和监测DSA形成的重要性，以尽量减少移植后免疫风险。
回顾性设计存在固有偏差，结果来自单一机构，且队列特别年轻。
无。
