Department of Pediatric Nephrology, Children's Hospital at Montefiore, Bronx, NY, USA.
Department of Surgery, Montefiore Transplant Immunology Laboratory, Bronx, NY, USA.
Pediatr Transplant. 2021 Mar;25(2):e13885. doi: 10.1111/petr.13885. Epub 2020 Nov 1.
Donor-specific antibody (DSA) is an independent risk factor for antibody-mediated rejection (ABMR) and graft loss. The C1q assay differentiates complement from non-complement-binding DSA and C1q-binding DSA may lead to poor allograft survival. Our aim was to characterize the type of DSA seen in pediatric kidney transplant recipients and to determine whether complement binding DSA was associated with inferior graft survival.This was a single-center retrospective study of 48 children who were transplanted between 2009 and 2016. DSA were monitored using Luminex single antigen beads. A negative crossmatch was required to proceed with transplantation. The median follow-up time was 4.9 (3.4, 7.9) years. The median age was 12 (5.7, 15.4) years. DSA developed in 27/48 (56.3%), while C1q-binding DSA developed in 17/27 (63%). There were no significant differences between DSA negative, C1q-binding DSA, and C1q negative DSA, with regard to the number of HLA-ABDR (P = .09) or HLA-DQ mismatches alone (P = .16). For both C1q negative and C1q-binding DSA, DQ was the most common target of the DSA (19/27; 70.4%). C1q-binding DSA was associated with a significantly higher frequency of biopsy proven rejection (76.5%) when compared to C1q negative (10%) and DSA negative (14.3%); P = .001. Graft loss was seen in 6 (12.5%), all of whom had C1q-binding DSA (P = .004). C1q-binding DSA was most commonly directed to DQ antigens. C1q-binding DSA was associated with increased rejection and graft loss. Monitoring for C1q-binding DSA may risk stratify recipients and guide physician management.
供者特异性抗体（DSA）是抗体介导排斥（ABMR）和移植物丢失的独立危险因素。C1q 检测可区分补体与非补体结合的 DSA，而 C1q 结合的 DSA 可能导致移植物存活率降低。我们的目的是描述儿科肾移植受者中所见的 DSA 类型，并确定补体结合的 DSA 是否与移植物存活率降低有关。
这是一项回顾性单中心研究，纳入了 2009 年至 2016 年间接受移植的 48 名儿童。使用 Luminex 单抗原珠监测 DSA。需要进行阴性交叉匹配才能进行移植。中位随访时间为 4.9 年（3.4 至 7.9 年）。中位年龄为 12 岁（5.7 至 15.4 岁）。27/48（56.3%）例出现 DSA，17/27（63%）例出现 C1q 结合的 DSA。在 HLA-ABDR 数量方面，DSA 阴性、C1q 结合的 DSA 和 C1q 阴性的 DSA 之间无显著差异（P=0.09），仅 HLA-DQ 错配也无显著差异（P=0.16）。对于 C1q 阴性和 C1q 结合的 DSA，DQ 都是最常见的 DSA 靶抗原（27/27；70.4%）。与 C1q 阴性（10%）和 DSA 阴性（14.3%）相比，C1q 结合的 DSA 与活检证实的排斥反应发生率显著升高（76.5%）有关；P=0.001。6 例（12.5%）发生移植物丢失，均有 C1q 结合的 DSA（P=0.004）。C1q 结合的 DSA 最常针对 DQ 抗原。C1q 结合的 DSA 与排斥反应和移植物丢失增加有关。监测 C1q 结合的 DSA 可能有助于对受者进行风险分层，并指导医生进行管理。
