在接受兔抗胸腺细胞球蛋白诱导和无类固醇方案的同时肝肾移植受者中，移植前供体特异性抗体与移植后肾脏结局之间缺乏关联。

Lack of Association between Pretransplant Donor-Specific Antibodies and Posttransplant Kidney Outcomes in Simultaneous Liver-Kidney Transplant Recipients with Rabbit Anti-Thymocyte Globulin Induction and Steroid-Free Protocol.

机构信息

James D. Eason Transplant Institute, Methodist University Hospital, Memphis, Tennessee, USA.

Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.

出版信息

Nephron. 2020;144(3):126-137. doi: 10.1159/000505460. Epub 2020 Jan 31.

DOI:10.1159/000505460

PMID:32007998

Abstract

INTRODUCTION AND OBJECTIVE

The impact of pretransplant donor-specific antibodies (DSAs), especially class II DSAs, on kidney allograft outcomes remains unclear in simultaneous liver-kidney transplantation (SLKT) recipients.

METHODS

We examined 85 recipients who consecutively underwent SLKT between 2009 and 2018 in our center. Associations between pretransplant DSA and worsening kidney function (WKF), kidney allograft loss, composite kidney outcome (WKF and/or antibody-mediated rejection and/or death-censored kidney allograft loss), death with functioning graft, and overall mortality were examined in survival analysis. WKF was defined as an eGFR decrease of 30% or greater from baseline, or 2 or more episodes of proteinuria, at least 90 days apart from each other.

RESULTS

The mean age at SLKT was 56 ± 10 years, and 62% of the recipients were male. More than one quarter (26%) of our recipients were African American. The 2 major causes of end-stage liver disease were hepatitis C (28%) and alcoholic hepatitis (26%). Nineteen recipients (22%) had pretransplant DSAs at the time of SLKT. The DSA(+) group and DSA(-) group had similar risk of WKF (unadjusted model: hazard ratio [HR] = 0.77, 95% confidence interval [CI]: 0.29-2.05 and adjusted model: HR = 0.36, 95% CI: 0.12-1.08); similar risk of composite kidney outcome (unadjusted model: HR = 1.04, 95% CI: 0.45-2.43 and adjusted model: HR = 0.53, 95% CI: 0.20-1.39); and similar risk of overall death (unadjusted model: HR = 1.23, 95% CI: 0.45-3.36 and adjusted model: HR = 1.28, 95% CI: 0.42-3.87). We found similar results when comparing different DSA subclasses (class I and II DSAs) with recipients without DSAs.

CONCLUSIONS

The presence of pretransplant DSAs was not associated with worse kidney allograft outcomes from our single-center experience. Further prospective larger studies are strongly warranted.

摘要

介绍和目的

在同时进行的肝肾移植（SLKT）受者中，移植前供体特异性抗体（DSA），尤其是 II 类 DSA，对肾移植结局的影响尚不清楚。

方法

我们检查了 2009 年至 2018 年间在我们中心连续进行 SLKT 的 85 名受者。在生存分析中，检查了移植前 DSA 与肾功能恶化（WKF）、肾移植丢失、复合肾结局（WKF 和/或抗体介导的排斥和/或死亡校正的肾移植丢失）、带功能移植物的死亡和总死亡率之间的关联。WKF 的定义为 eGFR 从基线下降 30%或更多，或蛋白尿至少 2 次，两次之间至少间隔 90 天。

结果

SLKT 的平均年龄为 56±10 岁，62%的受者为男性。超过四分之一（26%）的受者为非裔美国人。终末期肝病的两个主要原因是丙型肝炎（28%）和酒精性肝炎（26%）。19 名受者（22%）在 SLKT 时存在移植前 DSA。DSA（+）组和 DSA（-）组的 WKF 风险相似（未调整模型：危险比[HR] = 0.77，95%置信区间[CI]：0.29-2.05 和调整模型：HR = 0.36，95%CI：0.12-1.08）；复合肾结局的风险相似（未调整模型：HR = 1.04，95%CI：0.45-2.43 和调整模型：HR = 0.53，95%CI：0.20-1.39）；总死亡率的风险相似（未调整模型：HR = 1.23，95%CI：0.45-3.36 和调整模型：HR = 1.28，95%CI：0.42-3.87）。当比较无 DSA 受者与不同 DSA 亚类（I 类和 II 类 DSA）时，我们发现了相似的结果。