Itabashi Yoshihiro, Aikawa Atsushi, Muramatsu Masaki, Hyoudou Youji, Shinoda Kazunobu, Takahashi Yusuke, Sakurabayashi Kei, Mizutani Toshihide, Oguchi Hideyo, Arai Taichi, Kawamura Takeshi, Hamasaki Yuko, Sakai Ken, Shishido Seiichiro
From the Department of Nephrology, Toho University, Faculty of Medicine, Tokyo, Japan.
Exp Clin Transplant. 2019 Jan;17(Suppl 1):43-49. doi: 10.6002/ect.MESOT2018.L42.
We investigated outcomes in living-donor kidney transplant recipients with preformed donor-specific antibodies (detected with flow cytometry and specified with the LABScreen single antigen test) under desensitization pretransplant and immunosuppression posttransplant.
Of 15 recipients included, 8 had ABO-incompatible kidney transplant. Six patients had sensitization caused by pregnancy, 8 by blood transfusion, 5 by previous transplants, and 1 by unknown cause. Desensitization was initiated using calcineurin inhibitors, methylprednisolone, and mycophenolate mofetil 30 days pretransplant, with rituximab administered 1 and 10 days pretransplant. Patients underwent plasmapheresis 1, 3, and 5 days pretransplant. Antithymocyte globulin was admi nistered for 5 days posttransplant as induction therapy. At 3 and 12 months posttransplant, all recipients underwent protocol renal allograft biopsies, with donor-specific antibodies simultaneously measured with the single antigen test.
T-cell complement-dependent cytotoxicity crossmatch was negative in all 15 recipients, but T-cell and B-cell flow cytometry was positive in 8 and 14 recipients, respectively. Anti-HLA class I antibodies became negative, except in 1 recipient 3 months posttransplant. Class II antibodies remained positive in 8 recipients 3 months posttransplant. No clinical or subclinical T-cell-mediated rejection occurred, but 1 recipient experienced clinical acute antibody-mediated rejection. At 3 and 12 months posttransplant, 8 and 5 recipients had subclinical acute antibody-mediated rejection. Cytomegalovirus test showed positivity in 14 recipients, but none developed cytomegalovirus disease. BK viremia was detected in 2 recipients, with 1 developing BK virus nephropathy, which was reversed by reducing immunosuppression.
Transplant patients with preformed donor-specific antibodies showed good outcomes in terms of desensitization and immunosuppression. However, most anti-HLA class II donor-specific antibodies remained, and microvascular inflammation score could indicate long-term risk of renal allograft dysfunction.
我们研究了移植前进行脱敏治疗且移植后进行免疫抑制的活体供肾移植受者中预先形成的供者特异性抗体（通过流式细胞术检测并用LABScreen单抗原检测进行鉴定）的转归情况。
纳入的15名受者中，8例接受了ABO血型不相容肾移植。6例患者因妊娠致敏，8例因输血致敏，5例因既往移植致敏，1例致敏原因不明。移植前30天开始使用钙调神经磷酸酶抑制剂、甲泼尼龙和霉酚酸酯进行脱敏治疗，移植前1天和10天给予利妥昔单抗。患者在移植前1、3和5天接受血浆置换。移植后给予抗胸腺细胞球蛋白5天作为诱导治疗。移植后3个月和12个月，所有受者均接受方案规定的肾移植活检，同时用单抗原检测法检测供者特异性抗体。
15名受者的T细胞补体依赖细胞毒性交叉配型均为阴性，但8名和14名受者的T细胞和B细胞流式细胞术检测结果分别为阳性。除1例受者在移植后3个月外，抗HLAⅠ类抗体均转为阴性。移植后3个月，8名受者的Ⅱ类抗体仍为阳性。未发生临床或亚临床T细胞介导的排斥反应，但1例受者发生了临床急性抗体介导的排斥反应。移植后3个月和12个月，分别有8名和5名受者发生亚临床急性抗体介导的排斥反应。巨细胞病毒检测显示14名受者呈阳性，但均未发生巨细胞病毒疾病。2名受者检测到BK病毒血症，其中1名发生BK病毒肾病，通过减少免疫抑制得以逆转。
预先形成供者特异性抗体的移植患者在脱敏和免疫抑制方面显示出良好的转归。然而，大多数抗HLAⅡ类供者特异性抗体仍然存在，微血管炎症评分可能提示肾移植功能障碍的长期风险。
