针对第二位供体的同种抗体对再次肝移植长期预后的影响。
The impact of alloantibodies directed against the second donor on long-term outcomes of repeat liver transplantation.
作者信息
Xu Qingyong, Shrum Brad, Leckie Steve, Skaro Anton, McAlister Vivian C
机构信息
Department of Pathology and Lab Medicine, University of Western Ontario, London, ON, Canada.
Department of Surgery, University of Western Ontario, London, ON, Canada.
出版信息
Hepatobiliary Surg Nutr. 2019 Jun;8(3):246-252. doi: 10.21037/hbsn.2019.01.14.
BACKGROUND
Despite reports that associate donor specific antibody (DSA) with rejection after liver transplantation, grafts are still allocated according to blood group (ABO) but not human leukocyte antigen (HLA) compatibility, possibly due to the absence of an easily discernible clinical association between adverse recipient outcome and DSA. Re-transplantation provides a test environment where the presence of preformed DSA is prevalent and its effect on outcome should be apparent.
METHODS
All patients undergoing a second liver transplantation with available pre-operative serum were included with the exception of ABO incompatible or multiple organ transplants. Banked sera were tested for anti-HLA antibodies with Luminex-based solid phase assays. Anti-HLA antibodies to the second donor (D2SA) were determined using antibodies specificity and HLA typing of 2nd liver donor.
RESULTS
Preformed HLA antibodies directed to second liver transplantation (D2SA) were found in 31 (39%) of the 79 patients that were included in the study. Primary and re-transplantation characteristics were similar in both subgroups except first graft survival which was significantly shorter in recipients who are negative for D2SA. Mean survival of the second graft was similar in D2SA+ and D2SA- cohorts [8.55 (range, 0.01-24.74) 7.56 (range, 0-23.53) years respectively, P=0.574]. Mean patient survival after 2nd liver transplantation was similar in D2SA+ and D2SA- cohorts [9.11 (range, 0.01-24.74) 8.10 (range, 0-23.53) years respectively, P=0.504]. Subgroup univariate analysis demonstrated no detrimental effect of class, locus, or strength of D2SA on survival of the second liver transplant. In multivariate cox regression model, neither class I D2DSA (HR =1.101, P=0.92) nor class II D2SA (HR =1.74, P=0.359) were significant risks of graft failure.
CONCLUSIONS
Presence of D2SA was not found to be associated with inferior outcomes in this retrospective cohort study of liver re-transplantation suggesting that changes to the allocation system are not required.
背景
尽管有报道称供体特异性抗体（DSA）与肝移植后的排斥反应有关，但目前移植物仍根据血型（ABO）而非人类白细胞抗原（HLA）相容性进行分配，这可能是因为在不良受者结局与DSA之间缺乏易于识别的临床关联。再次移植提供了一个测试环境，在此环境中预先形成的DSA普遍存在，其对结局的影响应该很明显。
方法
纳入所有接受二次肝移植且术前血清可用的患者，但不包括ABO血型不相容或多器官移植患者。使用基于Luminex的固相分析检测储存血清中的抗HLA抗体。根据第二肝供体的抗体特异性和HLA分型确定针对第二供体的抗HLA抗体（D2SA）。
结果
在纳入研究的79例患者中，31例（39%）检测到针对二次肝移植的预先形成的HLA抗体（D2SA）。两个亚组的初次和再次移植特征相似，但D2SA阴性受者的首次移植物存活时间明显较短。D2SA阳性和D2SA阴性队列中二次移植物的平均存活时间相似[分别为8.55（范围，0.01 - 24.74）年和7.56（范围，0 - 23.53）年，P = 0.574]。二次肝移植后患者的平均存活时间在D2SA阳性和D2SA阴性队列中相似[分别为9.11（范围，0.01 - 24.74）年和8.10（范围，0 - 23.53）年，P = 0.504]。亚组单因素分析表明，D2SA的类别、位点或强度对二次肝移植的存活没有不利影响。在多变量Cox回归模型中，I类D2DSA（HR = 1.101，P = 0.92）和II类D2SA（HR = 1.74，P = 0.359）均不是移植物失败的显著风险因素。
结论
在这项肝再次移植的回顾性队列研究中，未发现D2SA的存在与较差的结局相关，这表明不需要改变分配系统。
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