Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
Emory University School of Medicine, Atlanta, Georgia.
Am J Transplant. 2020 Feb;20(2):573-581. doi: 10.1111/ajt.15585. Epub 2019 Oct 8.
Recent evidence suggests that belatacept reduces the durability of preexisting antibodies to class I and class II human leukocyte antigens (HLAs). In this case series of 163 highly sensitized kidney transplant candidates whose calculated panel-reactive antibody (cPRA) activity was ≥98% to 100%, the impact of belatacept on preexisting HLA antibodies was assessed. Of the 163 candidates, 72 underwent transplantation between December 4, 2014 and April 15, 2017; 60 of these transplanted patients remained on belatacept consecutively for at least 6 months. We observed a decrease in the breadth and/or strength of HLA class I antibodies as assessed by FlowPRA in belatacept-treated patients compared to controls who did not receive belatacept. Specifically, significant HLA antibody reduction was evident for class I (P < .0009). Posttransplant belatacept-treated patients also had a clinically significant reduction in their cPRA compared to controls (P < .01). Collectively, these findings suggest belatacept can reduce HLA class I antibodies in a significant proportion of highly sensitized recipients and could be an option to improve pretransplant compatibility with organ donors.
最近的证据表明，贝利尤单抗可降低预先存在的针对 I 类和 II 类人类白细胞抗原（HLA）的抗体的持久性。在这项针对 163 名高度致敏的肾移植候选者的病例系列研究中，其计算的群体反应性抗体（cPRA）活性≥98%至 100%，评估了贝利尤单抗对预先存在的 HLA 抗体的影响。在这 163 名候选者中，有 72 名于 2014 年 12 月 4 日至 2017 年 4 月 15 日期间接受了移植；其中 60 名接受移植的患者连续接受贝利尤单抗治疗至少 6 个月。与未接受贝利尤单抗治疗的对照组相比，我们观察到接受贝利尤单抗治疗的患者的 HLA 类 I 抗体的广度和/或强度下降，这是通过 FlowPRA 评估的。具体而言，I 类 HLA 抗体的显著减少是明显的（P<0.0009）。与对照组相比，移植后接受贝利尤单抗治疗的患者的 cPRA 也显著降低（P<0.01）。总的来说，这些发现表明，贝利尤单抗可在相当一部分高度致敏的受者中降低 HLA 类 I 抗体，并且可能是改善与器官供体移植前相容性的一种选择。
