Bouatou Yassine, Seyde Olivia, Moll Solange, Martin Pierre-Yves, Villard Jean, Ferrari-Lacraz Sylvie, Hadaya Karine
Division of Nephrology, Geneva University Hospitals, Rue Gabrielle Perret-Gentil 4, 1205, Geneva, Switzerland.
Institute of Clinical Pathology, Geneva University Hospitals, Geneva, Switzerland.
BMC Nephrol. 2018 Apr 12;19(1):86. doi: 10.1186/s12882-018-0886-5.
Donor-specific anti-human leukocyte antigen (HLA) antibodies (DSA) can be preformed or de novo (dn). Strategies to manage preformed DSA are well described, but data on the management and outcomes of dnDSA are lacking.
We performed a retrospective analysis of data from a single centre of the management and outcomes of 22 patients in whom a dnDSA was identified with contemporary and follow up biopsies.
Evolution from baseline to follow up revealed a statistically significant loss of kidney function (estimated glomerular filtration rate: 45.9 ± 16.7 versus 37.4 ± 13.8 ml/min/1.73 m; p = 0.005) and increase in the proportion of patients with transplant glomerulopathy (percentage with cg lesion ≥1: 27.2% vs. 45.4%; p = 0.04). Nine patients were not treated at the time of dnDSA identification, and 13 patients received various drug combinations (e.g., corticosteroids, plasmapheresis, thymoglobulins and/or rituximab). No significant pathological changes were observed for the various treatment combinations.
Our retrospective analysis of a small sample suggests that dnDSA should be considered a risk factor for the loss of kidney function independent of the baseline biopsy, and multidisciplinary evaluations of the transplant patient are a necessary requirement. Further confirmation in a multicentre prospective trial is required.
供者特异性抗人白细胞抗原（HLA）抗体（DSA）可以是预先存在的或新发的（dn）。预先存在的DSA的管理策略已有详细描述，但关于新发DSA的管理和结果的数据尚缺乏。
我们对来自单一中心的22例患者的数据进行了回顾性分析，这些患者通过当代及随访活检确定存在新发DSA，并分析了其管理情况和结果。
从基线到随访的变化显示，肾功能有统计学意义的下降（估计肾小球滤过率：45.9±16.7对37.4±13.8ml/min/1.73m²；p = 0.005），且移植肾小球病患者的比例增加（伴有cg病变≥1的百分比：27.2%对45.4%；p = 0.04）。9例患者在确定新发DSA时未接受治疗，13例患者接受了各种药物联合治疗（如皮质类固醇、血浆置换、抗胸腺细胞球蛋白和/或利妥昔单抗）。各种治疗组合均未观察到明显的病理变化。
我们对小样本的回顾性分析表明，新发DSA应被视为独立于基线活检的肾功能丧失的危险因素，对移植患者进行多学科评估是必要的。需要在多中心前瞻性试验中进一步证实。
