In Ji Won, Nam Minjeong, Rho Eun Youn, Shin Sue, Hong Yun Ji, Park Kyoung Un, Song Eun Young
Clin Lab. 2020 Jan 1;66(1). doi: 10.7754/Clin.Lab.2019.190706.
Plasmapheresis (PP) is commonly used for desensitization in highly sensitized patients with donor-specific antibodies (DSA) in living donor kidney transplantation. We analyzed the impact of DSA levels before and after desensitization on renal allograft outcome.
Twenty-three patients who underwent desensitization with PP, intravenous immunoglobulin (IVIG), and rituximab before kidney transplantation in Seoul National University Hospital from August 2006 to August 2016 were enrolled. The association of median fluorescent intensity (MFI) value of DSA with graft outcome was analyzed.
The frequency of positive HLA class II DSA after desensitization was lower in patients without antibody-mediated rejection (AMR) compared to those with AMR (p = 0.006). The cutoff value of MFI sum of HLA class II DSA after desensitization for predicting AMR was 2,122 with 63% sensitivity and 94% specificity. The frequency of moderate HLA class II DSA (MFI 5,000 - 10,000) after desensitization was significantly higher in patients with graft loss compared to those without graft loss (p = 0.02).
Weak HLA class II DSA after desensitization including PP, IVIG, and rituximab was related to AMR and moderate levels of HLA class II DSA after desensitization was related to graft loss in living donor kidney transplantation.
在活体供肾移植中，血浆置换（PP）常用于对具有供体特异性抗体（DSA）的高敏患者进行脱敏治疗。我们分析了脱敏前后DSA水平对肾移植结局的影响。
纳入2006年8月至2016年8月在首尔国立大学医院接受肾移植前采用PP、静脉注射免疫球蛋白（IVIG）和利妥昔单抗进行脱敏治疗的23例患者。分析DSA的中位荧光强度（MFI）值与移植结局的相关性。
与发生抗体介导排斥反应（AMR）的患者相比，未发生AMR的患者脱敏后HLA II类DSA阳性频率更低（p = 0.006）。脱敏后预测AMR的HLA II类DSA的MFI总和截断值为2122，敏感性为63%，特异性为94%。与未发生移植肾丢失的患者相比，发生移植肾丢失的患者脱敏后中度HLA II类DSA（MFI 5000 - 10000）的频率显著更高（p = 0.02）。
在活体供肾移植中，包括PP、IVIG和利妥昔单抗在内的脱敏后弱HLA II类DSA与AMR相关，脱敏后中度水平的HLA II类DSA与移植肾丢失相关。
