Kidney Pancreas Transplantation, Instituto de Trasplantes y Alta Complejidad (ITAC - Nephrology), Buenos Aires, Argentina.
CEFYBO - CONICET, Buenos Aires, Argentina.
Clin Transplant. 2020 Aug;34(8):e13998. doi: 10.1111/ctr.13998. Epub 2020 Jun 28.
In kidney transplantation, de novo donor-specific antibodies (DSA) correlate with poor graft survival, and Consensus Guidelines recommend a protocol biopsy. In pancreas transplantation, DSA are also associated with poor graft outcomes; however, there are no recommendations on protocol biopsies. We started an antibody screening protocol on pancreas transplant patients at 0, 3, 6, 12 months, and yearly. Patients with DSA or high MFI non-DSA were considered for protocol biopsies of both organs. Results: 143 pancreas recipients were screened. 84 patients had negative antibodies throughout the study, 11 patients were found to have antibodies at graft dysfunction, and 48 patients had positive antibodies at screening without acute organ dysfunction (study group). Among the 30 non-DSA patients, 9 had protocol simultaneous pancreas and kidney biopsies performed with negative results in all of them. In contrast, among the 18 DSA patients, 15 had these biopsies performed, and 47% presented with subclinical rejection of the kidney, the pancreas, or both. In addition, some of the DSA patients without a protocol biopsy presented with rejection during the first 15 months of follow-up. Conclusion: We conclude that protocol biopsies of both grafts may play a role in the follow-up of pancreas transplant patients with de novo DSA appearance.
在肾移植中，新出现的供体特异性抗体（DSA）与移植物存活率降低相关，共识指南建议进行方案活检。在胰腺移植中，DSA 也与移植物不良结局相关；然而，目前尚无关于方案活检的建议。我们开始对胰腺移植患者在 0、3、6、12 个月和每年进行抗体筛查方案。具有 DSA 或高 MFI 非 DSA 的患者被考虑进行两个器官的方案活检。结果：筛查了 143 例胰腺受者。84 例患者在整个研究期间抗体均为阴性，11 例患者在移植物功能障碍时发现抗体，48 例患者在无急性器官功能障碍时筛查出阳性抗体（研究组）。在 30 例非 DSA 患者中，有 9 例行方案同时胰腺和肾脏活检，所有患者的结果均为阴性。相比之下，在 18 例 DSA 患者中，有 15 例行这些活检，47%的患者出现了肾脏、胰腺或两者的亚临床排斥反应。此外，一些未进行方案活检的 DSA 患者在随访的前 15 个月内出现排斥反应。结论：我们得出结论，对于出现新的 DSA 的胰腺移植患者，对两个移植物进行方案活检可能在其随访中发挥作用。
