群体反应性抗体对活体肾供体移植中移植物存活的影响：墨西哥韦拉克鲁斯一家移植中心的十年分析

Effect of Panel-Reactive Antibody on Graft Survival in Living Kidney Donor Transplantation: Analysis of 10 Years in a Transplant Center in Veracruz, Mexico.

作者信息

Martinez-Mier Gustavo, Vazquez-Crespo Luis Vicente, Angeles-Hernández Fausto, Viñas-Dozal Julio Cesar, Moreno-Ley Pedro I, Budar-Fernández Luis F, Méndez-López Marco T, Allende-Castellanos Carlos A, Jiménez-López Luis A, Bonilla-Casas Elias, De la Paz-Román Maritza, Fuentes-Zamudio Einar Eduardo

机构信息

Department of Organ Transplantation, Instituto Mexicano del Seguro Social Unidad Medica de Alta Especialidad Hospital de Especialidades 14 Adolfo Ruiz Cortines, Veracruz, Mexico; Veracruz State College of Surgeons, Veracruz, Mexico.

School of Medicine, Universidad Veracruzana Región Veracruz, Veracruz, México.

出版信息

Transplant Proc. 2020 May;52(4):1140-1142. doi: 10.1016/j.transproceed.2020.01.060. Epub 2020 Mar 25.

DOI:10.1016/j.transproceed.2020.01.060

PMID:32220481

Abstract

BACKGROUND

Pretransplant anti-HLA antibodies are a risk factor for graft rejection and loss, and its percentage estimate is known as panel-reactive antibody (PRA). Our objective was to evaluate the influence of PRA on the survival of renal grafts from living donors over a period of 10 years.

METHODS

Retrospective analysis was completed in all living donor transplants with PRA class I and class II from October 2008 to December 2018 with follow-up until June 2019. The methods used for the PRA were flow cytometry and Luminex. Graft survival (not censored) was evaluated by Kaplan-Meier (log-rank) and Cox regression. P < .05 was considered significant.

RESULTS

The study included 393 patients. PRA class I mean was 9.8 ± 20% (0%-98%) and class II mean was 8.6 ± 17.8% (0%-97.8%). Of the patients, 81.9% had a PRA <20% for any class. Uncensored graft survival at 1, 5, and 10 years was 90.3%, 76.2%, and 69.3%, respectively. Mean estimated uncensored graft survival in PRA <20% patients (103.9 ± 2.7, 95% confidence interval [CI] 96.6-11.2) was higher than that of PRA >20% patients (61.5 ± 5.7, 95% CI 50.3-72.8) (P = .005 log-rank). Cox regression (univariate) was statistically significant for PRA class I (Exp [B] 1.01, 95% CI 1.003-1.02, P = .009) and for PRA >20% any class (Exp [B] 2.074, 95% CI 1.222-3.520, P = .007).

CONCLUSION

PRA class I and PRA >20% any class are associated with lower graft survival. PRA must be considered to determine immunologic risk and to choose an immunosuppressive regimen in kidney transplantation.

摘要

背景

移植前抗人类白细胞抗原（HLA）抗体是移植物排斥和丢失的一个危险因素，其百分比估计值称为群体反应性抗体（PRA）。我们的目的是评估PRA对活体供肾移植10年生存率的影响。

方法

对2008年10月至2018年12月期间所有进行I类和II类PRA检测的活体供者移植进行回顾性分析，并随访至2019年6月。PRA检测采用流式细胞术和Luminex技术。采用Kaplan-Meier（对数秩）和Cox回归评估移植物生存率（未删失）。P < 0.05被认为具有统计学意义。

结果

该研究纳入393例患者。I类PRA平均为9.8±20%（0%-98%），II类PRA平均为8.6±17.8%（0%-97.8%）。其中，81.9%的患者任何类别PRA <20%。1年、5年和10年未删失的移植物生存率分别为90.3%、76.2%和69.3%。PRA <20%患者的平均估计未删失移植物生存率（103.9±2.7，95%置信区间[CI] 96.6-11.2）高于PRA >20%患者（61.5±5.7，95% CI 50.3-72.8）（P = 0.005对数秩）。Cox回归（单因素）显示，I类PRA（Exp[B] 1.01，95% CI 1.003-1.02，P = 0.009）和任何类别PRA >20%（Exp[B] 2.074，95% CI 1.222-3.520，P = 0.007）具有统计学意义。