Groeneweg Koen E, van der Toorn Fréderique A, Roelen Dave L, van Kooten Cees, Heidt Sebastiaan, Claas Frans H J, Reinders Marlies E J, de Fijter Johan W, Soonawala Darius
Department of Internal Medicine (Nephrology), Leiden University Medical Center, the Netherlands.
Department of Internal Medicine (Nephrology), Leiden University Medical Center, the Netherlands.
Transpl Immunol. 2021 Aug;67:101407. doi: 10.1016/j.trim.2021.101407. Epub 2021 May 8.
Female recipients of a spousal donor kidney transplant are at greater risk of donor-specific pre-immunization, which may increase the risk of acute antibody-mediated rejection (ABMR). We assessed the incidence of early ABMR (within two weeks after transplantation), risk factors for ABMR and graft function in 352 complement-dependent cytotoxicity test-negative LURD transplant recipients, transplanted between 1997 and 2014 at the Leiden University Medical Center in The Netherlands. Risk factors for immunization were retrieved from the health records. As methods to screen for preformed donor-specific antibodies (pDSA) have developed through time, we retrospectively screened those with ABMR for pDSA using pooled-antigen bead (PAB) and single-antigen bead (SAB) assays. The cumulative incidence of rejection in the first six months after transplantation was 18% (TCMR 15%; early ABMR 3%). Early ABMR resulted in inferior graft survival and was more common in women who received a kidney from their spouse (10%) than in other women (2%) and men (<1%). The SAB assay retrospectively identified pDSA in seven of nine cases of early ABMR (78%), while the PAB detected pDSA in only three cases (33%). Seeing that early ABMR occurred in 10% of women who received a kidney from their spouse, a SAB assay should be included in the pre-transplant assessment of this group of women, regardless of the result of the PAB assay.
接受配偶活体供肾移植的女性受者发生供者特异性预致敏的风险更高，这可能会增加急性抗体介导性排斥反应（ABMR）的风险。我们评估了1997年至2014年间在荷兰莱顿大学医学中心接受移植的352例补体依赖细胞毒性试验阴性的活体供肾移植受者中早期ABMR（移植后两周内）的发生率、ABMR的危险因素及移植肾功能。从健康记录中获取免疫相关的危险因素。由于检测预先存在的供者特异性抗体（pDSA）的方法随时间不断发展，我们采用混合抗原微珠（PAB）和单一抗原微珠（SAB）检测法，对发生ABMR的患者进行pDSA的回顾性筛查。移植后前六个月排斥反应的累积发生率为18%（T细胞介导性排斥反应占15%；早期ABMR占3%）。早期ABMR导致移植肾存活率降低，在接受配偶供肾的女性中更为常见（10%），高于其他女性（2%）和男性（<1%）。SAB检测法回顾性鉴定出9例早期ABMR患者中的7例（78%）存在pDSA，而PAB检测法仅在3例（33%）中检测到pDSA。鉴于接受配偶供肾的女性中有10%发生早期ABMR，无论PAB检测结果如何，对这组女性进行移植前评估时均应采用SAB检测法。
