采用亲属间活体肾移植配对交换项目提高 HLA 配型。

Improving HLA matching in living donor kidney transplantation using kidney paired exchange program.

机构信息

Blood and Transplantation Center of Porto, Instituto Português do Sangue e da Transplantação, Porto, Portugal; Unit for Multidisciplinary Research in Biomedicine (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal.

Unit for Multidisciplinary Research in Biomedicine (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal; Department of Nephrology, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Portugal.

出版信息

Transpl Immunol. 2020 Oct;62:101317. doi: 10.1016/j.trim.2020.101317. Epub 2020 Jul 4.

DOI:10.1016/j.trim.2020.101317

PMID:32634478

Abstract

BACKGROUND

The inclusion of compatible pairs within kidney paired exchange programs has been described as a way to enhance these programs. Improved immunological matching for the recipient in compatible pair has been described to be a possible benefit.

METHODS

The main purpose of our study was to determine if the introduction of compatible pairs in the Portuguese kidney paired exchange program would result in a better match for these patients, but also to assess if this strategy would increase the number of incompatible pairs with a possible match. We included 17 compatible pairs in kidney paired exchange pool of 35 pairs and performed an in-silico simulation determining HLA eplet mismatch load between the co-registered and matched pairs using HLA MatchMaker, version 3.0.

RESULTS

Our study showed that the inclusion of fully HLA-A, -B, -DR mismatched compatible pairs within the national Portuguese KEP increased matched rate within ICP (0.71%) and improved HLA eplet matching within compatible pairs. 16 of 17 (94.12%) of the CP obtained one or more transplants possibilities and 13 (81.25%) would have been transplanted with significantly lower HLA class I and class II total and antibody-verified eplet mismatch load (83.9 ± 16.9 vs. 59.8 ± 12.2, P = .002 and 30.1 ± 5.5 vs. 21.2 ± 3.0, P = .003, respectively).

CONCLUSIONS

This strategy is a viable alternative for compatible pairs seeking a better matched kidney and Portuguese KEP program should allow them this possibility.

摘要

背景

在肾对匹配交换计划中纳入相容对已被描述为增强这些计划的一种方法。据描述，为受体进行相容对的免疫匹配改善可能是一种获益。

方法

我们研究的主要目的是确定在葡萄牙肾对匹配交换计划中引入相容对是否会为这些患者带来更好的匹配，但也要评估这种策略是否会增加具有可能匹配的不相容对的数量。我们在 35 对的肾对匹配交换池中纳入了 17 对完全 HLA-A、-B、-DR 错配的相容对，并使用 HLA MatchMaker 版本 3.0 进行了计算机模拟，以确定共同登记和匹配对之间 HLA 表位错配负荷。

结果

我们的研究表明，在全国性的葡萄牙 KEP 中纳入完全 HLA-A、-B、-DR 错配的相容对会增加 ICP 内的匹配率（0.71%），并改善相容对内的 HLA 表位匹配。17 对 CP 中的 16 对（94.12%）获得了一个或多个移植的可能性，并且 13 对（81.25%）将进行移植，HLA Ⅰ类和Ⅱ类总以及抗体验证的表位错配负荷显著降低（83.9±16.9 比 59.8±12.2，P=0.002 和 30.1±5.5 比 21.2±3.0，P=0.003）。