Colombe B W, Lou C D, Salvatierra O, Garovoy M R
Immunogenetics and Transplantation Laboratory, University of California School of Medicine, San Francisco, California 94143.
Transplantation. 1987 Oct;44(4):509-15. doi: 10.1097/00007890-198710000-00010.
Characteristics of the sensitization response to donor-specific transfusion (DST) have been studied in the context of the pretransfusion panel reactive antibody (PRA) status of the recipient. Two distinct patterns of response to DST and Imuran treatment have been found. In patients with one-haplotype-matched donors, the panel nonreactive patient (PRA less than 10%) has a 19% incidence of DST sensitization that is further reduced by Imuran treatment to 6%; antibodies are both anti-T cell and anti-B cells, are transient, and are specific to the mismatched HLA antigens of the blood donor. Panel-reactive patients (PRA greater than 10%) have a 56% incidence of DST sensitization; the antibodies appear within 2 weeks of the first transfusion, are anti-T cell, and are generally of broad specificity and persistent duration consistent with amplification of a previous antigenic exposure; Imuran seems to have little or no effect in reducing the incidence of sensitization in these panel-reactive patients. However, panel reactive patients whose PRA levels spontaneously fall to panel-nonreactive levels immediately prior to DST therapy have an exceedingly low (0-8%) incidence of sensitization with or without Imuran coverage.
已在受者输血前群体反应性抗体（PRA）状态的背景下研究了对供者特异性输血（DST）致敏反应的特征。发现了两种对DST和硫唑嘌呤治疗的不同反应模式。在单倍型匹配供者的患者中，群体反应阴性患者（PRA低于10%）的DST致敏发生率为19%，经硫唑嘌呤治疗后进一步降至6%；抗体既有抗T细胞抗体又有抗B细胞抗体，是短暂性的，且针对献血者不匹配的HLA抗原具有特异性。群体反应性患者（PRA高于10%）的DST致敏发生率为56%；抗体在首次输血后2周内出现，是抗T细胞抗体，通常具有广泛的特异性且持续时间较长，这与既往抗原暴露的放大作用一致；硫唑嘌呤似乎对降低这些群体反应性患者的致敏发生率几乎没有作用或根本没有作用。然而，在DST治疗前PRA水平自发降至群体反应阴性水平的群体反应性患者，无论有无硫唑嘌呤覆盖，其致敏发生率都极低（0 - 8%）。
