在接受血液透析的肾移植受者中，新产生的 HLA 供体特异性抗体（HLA-DSA）、HLA 抗体（HLA-Ab）和同种异体移植物排斥反应的发展。

Development of de novo HLA donor specific antibodies (HLA-DSA), HLA antibodies (HLA-Ab) and allograft rejection post blood transfusion in kidney transplant recipients.

机构信息

Division of Nephrology, Department of Medicine, University Malaya Medical Centre, 59100 Kuala Lumpur, Malaysia; Central Northern Adelaide Renal and Transplant Services (CNARTS), Royal Adelaide Hospital, 5000 Adelaide, SA, Australia.

Central Northern Adelaide Renal and Transplant Services (CNARTS), Royal Adelaide Hospital, 5000 Adelaide, SA, Australia; South Australian Transplantation and Immunogenetics Laboratory, Women's and Children's Hospital, 5006 North Adelaide, SA, Australia.

出版信息

Hum Immunol. 2020 Jul;81(7):323-329. doi: 10.1016/j.humimm.2020.04.002. Epub 2020 Apr 21.

DOI:10.1016/j.humimm.2020.04.002

PMID:32327243

Abstract

BACKGROUND

Blood transfusion during the post-operative period of kidney transplantation is common as part of a life-saving procedure, especially in the event of acute blood loss. However, there have been conflicting opinions since the pre-cyclosporine era. The risk of sensitization post-transfusion remains the main limiting factor following transfusion in kidney transplant recipients. Thus, the objective of this study is to assess the development of de novo HLA-DSA, HLA-Ab and allograft rejection post blood transfusion.

METHODOLOGY

This is a retrospective cohort study recruiting all kidney transplant recipients in South Australia from January 2010 till December 2018. Following that, the incidence of blood transfusion within one week post-operatively were traced (transfusion group). The outcomes were compared with all other transplant recipients (non-transfusion group). Recipient's demographic, donor characteristics and immunological risk profiles were obtained from the transplant unit database, while the biopsy report, history of blood transfusion, latest serum creatinine and follow-up status was gathered from the electronic medical system (OASIS). The HLA-DSA and HLA-Ab results were collected from the NOMS database. Finally, the survival data were merged with the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry for South Australia recipients graft survival.

RESULTS

A total of 699 patients were eligible for analysis. The mean age was 50.64 ± 13.23 years old. There were more elderly (>65 years old) and females who needed transfusion. The majority had glomerulonephritis as the primary disease. There was no statistical difference in donor characteristics, cold ischemic time and immunological risk between the transfusion and non-transfusion group. There was no difference in the development of de novo HLA-DSA, HLA-Ab and rejection episodes between the group and the results were consistent in a model adjusted for all potential confounders. Median graft survival in days between the transfusion vs non-transfusion group was 1845 IQR (961,2430) and 1250 IQR (672,2013).

CONCLUSION

Blood transfusion under strong immunosuppressive cover within a one-week post-operative period is safe with no significant association with the development of de novo HLA-DSA, HLA-Ab or clinical rejection.

摘要

背景

在肾移植的术后期间输血是常见的救命措施，特别是在发生急性失血的情况下。然而，在环孢素前时代以来，人们的观点一直存在冲突。输血后致敏的风险仍然是肾移植受者输血的主要限制因素。因此，本研究的目的是评估输血后新出现的 HLA-DSA、HLA-Ab 和同种异体移植物排斥反应的发生情况。

方法

这是一项回顾性队列研究，纳入了 2010 年 1 月至 2018 年 12 月期间南澳大利亚州的所有肾移植受者。随后，追踪了术后一周内的输血情况（输血组）。将结果与所有其他移植受者（非输血组）进行比较。从移植单位数据库中获取受者的人口统计学、供者特征和免疫风险概况，从电子医疗系统（OASIS）中获取活检报告、输血史、最新血清肌酐和随访情况。从 NOMS 数据库中收集 HLA-DSA 和 HLA-Ab 结果。最后，将生存数据与澳大利亚和新西兰透析和移植（ANZDATA）登记处的南澳大利亚州受者移植物生存情况进行合并。

结果

共有 699 名患者符合分析条件。平均年龄为 50.64±13.23 岁。输血组中老年人（>65 岁）和女性比例较高。大多数患者的主要疾病为肾小球肾炎。输血组和非输血组在供者特征、冷缺血时间和免疫风险方面无统计学差异。两组新出现的 HLA-DSA、HLA-Ab 和排斥反应发生率无差异，在调整所有潜在混杂因素的模型中结果一致。输血组和非输血组的中位移植物存活天数分别为 1845 IQR（961，2430）和 1250 IQR（672，2013）。