Zhang Ji, Liu Dong, Zhang Caixin, Zhou Min, Lv Jian, Wang Hongmei, Yang Hang, Fan Li, Wu Bo, Chen Jingyu
Wuxi Lung Transplant Center, Wuxi People's Hospital affiliated to Nanjing Medical University, Wuxi 214023, China.
Department of Lung Transplantation, Center for Lung Transplantation, Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing 100000, China.
Ann Transl Med. 2020 Feb;8(3):37. doi: 10.21037/atm.2019.10.45.
The importance of HLA antigen matching is widely recognized and accepted worldwide. With the improvement of diagnostic methods, recent studies have shown that eplet mismatched for organ transplantation is essential. In the field of lung transplantation, eplet mismatch (MM) is closely related to chronic rejection after lung transplantation. To further investigate the relationship between early graft failure and acute rejection, we performed high-resolution HLA analysis on 59 patients in our center.
We conduct high-resolution HLA matching and Donor specific antibody (DSA) monitoring on 59 lung transplantation donors and recipients from April 1, 2018, to June 30, 2019. Baseline data were collected composed of both recipient characteristics and transplant-related features. Clinical outcomes were primary graft dysfunction (PGD) and acute rejection (AR).
Overall, for these 59 patients, HLA antigen mismatch is 7.19±1.61, eplet mismatch is 8.31±1.75 (P=0.0005). As the number of mismatch sites increases, the severity of PGD increased significantly, especially when presented both eplet mismatch and HLA-DQ mismatch. In this group of patients, 2 cases of antibody-mediated rejection (AMR) occurred after transplantation, eplet MM 9 (HLA-DQ MM 2) and eplet MM 5 (HLA-DQ MM1). Both patients developed DSA after operation, and they are DQB1 06:01 and C07:02, respectively. There were 9 cases of death during the perioperative period. Five of them died of severe PGD, and 4 died of severe infection. All these 9 patients were with high-level eplet MM and HLA-DQ MM.
Perioperative PGD and AR closely related to HLA mismatches, especially eplet and HLA-DQ MM. It might be noteworthy to do complementary detection of eplet matching and DSA in lung transplant donors and recipients, to predict the risk of early PGD and acute rejection after lung transplantation.
HLA抗原匹配的重要性在全球范围内得到广泛认可和接受。随着诊断方法的改进，最近的研究表明，器官移植中的表位错配至关重要。在肺移植领域，表位错配（MM）与肺移植后的慢性排斥反应密切相关。为了进一步研究早期移植失败与急性排斥反应之间的关系，我们对本中心的59例患者进行了高分辨率HLA分析。
我们对2018年4月1日至2019年6月30日期间的59例肺移植供受者进行了高分辨率HLA匹配和供者特异性抗体（DSA）监测。收集了由受者特征和移植相关特征组成的基线数据。临床结局为原发性移植功能障碍（PGD）和急性排斥反应（AR）。
总体而言，这59例患者的HLA抗原错配为7.19±1.61，表位错配为8.31±1.75（P = 0.0005）。随着错配位点数量的增加，PGD的严重程度显著增加，尤其是当同时存在表位错配和HLA-DQ错配时。在这组患者中，移植后发生了2例抗体介导的排斥反应（AMR），表位MM分别为9（HLA-DQ MM为2）和表位MM为5（HLA-DQ MM为1）。两名患者术后均产生了DSA，分别为DQB1 06:01和C07:02。围手术期有9例死亡。其中5例死于严重的PGD，4例死于严重感染。所有这9例患者均存在高水平的表位MM和HLA-DQ MM。
围手术期PGD和AR与HLA错配密切相关，尤其是表位和HLA-DQ MM。在肺移植供受者中进行表位匹配和DSA的补充检测，以预测肺移植后早期PGD和急性排斥反应的风险，可能是值得注意的。
