Bynum Jennifer P, Zachary Andrea, Ness Paul M, Luo Xun, Bagnasco Serena, King Karen E, Segev Dorry L, Orandi Babak J, Warren Daniel S, Fuller Alice, Ciappi Ana, Montgomery Robert, Tobian Aaron A R
Department of Pathology.
Department of Medicine.
Transfusion. 2018 Aug;58(8):1951-1957. doi: 10.1111/trf.14800. Epub 2018 Sep 1.
Antibody-mediated rejection (AMR) is a major barrier to the long-term function of renal allografts. White blood cells, which may be present in red blood cell (RBC) units, and platelets (PLTs) express HLA antigens that may increase the risk of AMR by inducing or increasing humoral sensitization to HLA.
A retrospective cohort study of HLA-incompatible (HLAi) renal transplant recipients between 2004 and 2015 was conducted. Data on apheresis PLT and leukoreduced RBC transfusions within 4 weeks of transplantation, demographic information, and biopsy-proven AMR were collected from medical records and the Scientific Registry of Transplant Recipients. Patients were evaluated until they showed evidence of AMR or until 1 year posttransplant, whichever came first. Multivariable analysis with Cox modeling was performed.
Of 244 individuals, 182 (74.6%) received RBCs and 20 (8.2%) of those also received PLTs. During the first year posttransplant, 97 (39.8%) had AMR. RBC-alone or RBC and PLT transfusions were not associated with increased risk of AMR after adjustment for panel-reactive antibody, years on dialysis, HLA antibody strength, and number of therapeutic plasma exchange treatments (adjusted hazard ratio [adjHR] 1.00, 95% confidence interval [95% CI] 0.59-1.69; and adjHR 0.68, 95% CI 0.28-1.68, respectively). For each 1-unit increase in RBC transfusions, there was no association with AMR (adjHR 0.94, 95% CI 0.85-1.05). Only HLA antibody strength before transplantation was associated with AMR (adjHR 2.23, 95% CI 1.10-4.52; cytotoxic crossmatch compared to crossmatch negative but detectable donor-specific HLA antibodies).
Patients who receive an HLAi transplant who are transfused with leukoreduced RBCs or PLTs in the peritransplant period are at no higher risk of AMR than nontransfused patients.
抗体介导的排斥反应（AMR）是肾移植长期功能的主要障碍。红细胞（RBC）单位中可能存在的白细胞以及血小板（PLT）表达HLA抗原，这可能通过诱导或增加对HLA的体液致敏作用而增加AMR的风险。
对2004年至2015年间HLA不相容（HLAi）肾移植受者进行了一项回顾性队列研究。从医疗记录和移植受者科学登记处收集移植后4周内的单采血小板和白细胞滤除红细胞输血数据、人口统计学信息以及活检证实的AMR情况。对患者进行评估，直至出现AMR证据或移植后1年，以先出现者为准。采用Cox模型进行多变量分析。
在244名个体中，182名（74.6%）接受了红细胞输血，其中20名（8.2%）还接受了血小板输血。移植后第一年，97名（39.8%）发生了AMR。在调整了群体反应性抗体、透析年限、HLA抗体强度和治疗性血浆置换治疗次数后，单纯红细胞输血或红细胞和血小板输血与AMR风险增加无关（调整后风险比[adjHR]分别为1.00，95%置信区间[95%CI]为0.59 - 1.69；以及adjHR为0.68，95%CI为0.28 - 1.68）。红细胞输血每增加1个单位，与AMR无关联（adjHR为0.94，95%CI为0.85 - 1.05）。仅移植前的HLA抗体强度与AMR相关（adjHR为2.23，95%CI为1.10 - 4.52；细胞毒性交叉配型与交叉配型阴性但可检测到供体特异性HLA抗体相比）。
在围移植期接受白细胞滤除红细胞或血小板输血的HLAi移植患者发生AMR的风险并不高于未输血患者。
