Department of Nephrology and Organ Transplant Unit, Specialties Hospital, National Western Medical Centre, Mexican Institute of Social Security, Guadalajara, Jalisco, México.
Department of Physiology, University Health Sciences Center, University of Guadalajara, Guadalajara, Jalisco, México.
Int J Immunopathol Pharmacol. 2021 Jan-Dec;35:20587384211000545. doi: 10.1177/20587384211000545.
Minimization in immunosuppression could contribute to the appearance the donor-specific HLA antibodies (DSA) and graft failure. The objective was to compare the incidence of DSA in renal transplantation (RT) in recipients with immunosuppression with and without steroids. A prospective cohort from March 1st, 2013 to March 1st, 2014 and follow-up (1 year), ended in March 2015, was performed in living donor renal transplant (LDRT) recipients with immunosuppression and early steroid withdrawal (ESW) and compared with a control cohort (CC) of patients with steroid-sustained immunosuppression. All patients were negative cross-matched and for DSA pre-transplant. The regression model was used to associate the development of DSA antibodies and acute rejection (AR) in subjects with immunosuppressive regimens with and without steroids. Seventy-seven patients were included (30 ESW and 47 CC). The positivity of DSA class I (13% vs 2%; < 0.05) and class II (17% vs 4%, = 0.06) antibodies were higher in ESW versus CC. The ESW tended to predict DSA class II (RR 5.7; CI (0.93-34.5, = 0.06). T-cell mediated rejection presented in 80% of patients with DSA class I ( = 0.07), and 86% with DSA II ( = 0.03), and was associated with DSA class II, (RR 7.23; CI (1.2-44), = 0.03). ESW could favor the positivity of DSA. A most strictly monitoring the DSA is necessary for the early stages of the transplant to clarify the relationship between T-cell mediated rejection and DSA.
免疫抑制的最小化可能导致供体特异性 HLA 抗体 (DSA) 的出现和移植物衰竭。目的是比较接受免疫抑制治疗且不使用类固醇的肾移植 (RT) 患者中 DSA 的发生率。一项前瞻性队列研究于 2013 年 3 月 1 日至 2014 年 3 月 1 日进行，并进行了随访（1 年），于 2015 年 3 月结束，该研究纳入了接受免疫抑制治疗且早期停用类固醇（ESW）的活体供肾移植 (LDRT) 受者，并与接受类固醇维持免疫抑制的对照组 (CC) 患者进行了比较。所有患者在移植前均进行了交叉配型和 DSA 检测。使用回归模型来关联具有和不具有类固醇的免疫抑制方案的受试者中 DSA 抗体和急性排斥反应 (AR) 的发展。共纳入 77 例患者（ESW 组 30 例，CC 组 47 例）。ESW 组 DSA Ⅰ类（13%比 2%， < 0.05）和Ⅱ类（17%比 4%， = 0.06）抗体阳性率更高。ESW 倾向于预测 DSA Ⅱ类（RR 5.7；CI（0.93-34.5， = 0.06）。Ⅰ类 DSA 患者中有 80%（ = 0.07）和Ⅱ类 DSA 患者中有 86%（ = 0.03）发生 T 细胞介导的排斥反应，且与 DSA Ⅱ类相关（RR 7.23；CI（1.2-44）， = 0.03）。ESW 可能有利于 DSA 的阳性。在移植早期需要对 DSA 进行最严格的监测，以明确 T 细胞介导的排斥反应和 DSA 之间的关系。
