Halpern Samantha E, Rush Caroline K, Edwards R Whitney, Brennan Todd V, Barbas Andrew S, Pollara Justin
From the School of Medicine, Duke University, Durham, North Carolina, USA.
Exp Clin Transplant. 2021 Jul;19(7):635-644. doi: 10.6002/ect.2020.0425. Epub 2021 Apr 16.
Complement activation in organs from deceased donors is associated with allograft injury and acute rejection. Because use of organs from donors after circulatory death is increasing, we characterized relative levels of complement activation in organs from donors after brain death and after circulatory death and examined associations between donor complement factor levels and outcomes after kidney and liver transplant.
Serum samples from 65 donors (55 donations after brain death, 10 donations after circulatory death) were analyzed for classical, lectin, alternative, and terminal pathway components by Luminex multiplex assays. Complement factor levels were compared between groups, and associations with posttransplant outcomes were explored.
Serum levels of the downstream complement activation product C5a were similar in organs from donors after circulatory death versus donors after brain death. In organs from donors after circulatory death, complement activation occurred primarily via the alternative pathway; the classical, lectin, and alternative pathways all contributed in organs from donors after brain death. Donor complement levels were not associated with outcomes after kidney transplant. Lower donor complement levels were associated with need for transfusion, reintervention, hospital readmission, and acute rejection after liver transplant.
Complement activation occurs at similar levels in organs donated from donors after circulatory death versus those after brain death. Lower donor complement levels may contribute to adverse outcomes after liver transplant. Further study is warranted to better understand how donor complement activation contributes to posttransplant outcomes.
已故供体器官中的补体激活与同种异体移植损伤和急性排斥反应相关。由于循环死亡后供体器官的使用正在增加，我们对脑死亡供体和循环死亡供体器官中补体激活的相对水平进行了表征，并研究了供体补体因子水平与肾移植和肝移植后结局之间的关联。
通过Luminex多重分析对65名供体（55例脑死亡后捐献，10例循环死亡后捐献）的血清样本进行经典、凝集素、替代和终末途径成分分析。比较各组之间的补体因子水平，并探讨与移植后结局的关联。
循环死亡后供体器官与脑死亡后供体器官中，下游补体激活产物C5a的血清水平相似。在循环死亡后供体的器官中，补体激活主要通过替代途径发生；在脑死亡后供体的器官中，经典、凝集素和替代途径均有参与。供体补体水平与肾移植后的结局无关。较低的供体补体水平与肝移植后输血需求、再次干预、住院再入院和急性排斥反应相关。
循环死亡后供体捐献的器官与脑死亡后供体捐献的器官中，补体激活水平相似。较低的供体补体水平可能导致肝移植后的不良结局。有必要进一步研究，以更好地了解供体补体激活如何影响移植后结局。
