National Peripheral Histocompatibility Center, Immunology Department, Hippokration General Hospital, Thessaloniki, Greece.
Department of Nephrology, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece.
Transplant Proc. 2021 Nov;53(9):2765-2768. doi: 10.1016/j.transproceed.2021.08.032. Epub 2021 Sep 29.
De novo donor-specific antibodies (dnDSA) are associated with antibody-mediated rejection leading to kidney transplant failure. However, many transplant patients are stable with no signs of graft dysfunction at the time of dnDSA detection at screening test.
We prospectively studied 26 kidney transplant patients for 3 years, with dnDSA detected using the Luminex single-antigen bead assay in a routine test. Proteinuria and estimated glomerular filtration rate were evaluated along with dnDSA monitoring at least annually.
Graft loss associated with dnDSA occurred in 8 (31%) patients, 14 ± 11 months after the initial detection of dnDSA. These patients had more frequently multiple dnDSA (P = .004) and remarkable proteinuria, more than 1 g daily (P < .001). The remaining 18 patients were followed for 38 ± 15 months and considered stable as there was no deterioration regarding estimated glomerular filtration rate and proteinuria. In 7 (39%) of these patients, dnDSA waned and were not detected anymore at follow-up. Antibodies against HLA class I had a significantly (P < .001) lower mean fluorescence intensity (MFI) (2603 ± 1098) compared with those against HLA class II (11,109 ± 6414). In regression analysis, they were predictive of dnDSA wane (P = .043; odds ratio, 0.18; 95% confidence interval, 0.04-0.94). Despite fluctuations during follow-up, there was no significant change in MFI for those who retained the dnDSA.
The presence of dnDSA is transient in a significant proportion of stable renal transplant patients, especially in those with antibodies against HLA class I and a low MFI. Multiple dnDSA and severe proteinuria adversely affect renal graft survival.
新产生的供体特异性抗体（dnDSA）与抗体介导的排斥反应有关，导致肾移植失败。然而，许多移植患者在筛查试验中检测到 dnDSA 时没有出现移植物功能障碍的迹象，但处于稳定状态。
我们前瞻性研究了 26 例肾移植患者 3 年，使用 Luminex 单抗原珠检测法在常规检测中检测 dnDSA。至少每年评估蛋白尿和估算肾小球滤过率，并监测 dnDSA。
与 dnDSA 相关的移植物丢失发生在 8 例（31%）患者中，在首次检测到 dnDSA 后 14 ± 11 个月。这些患者有更多的 dnDSA（P =.004）和显著的蛋白尿，每天超过 1 克（P <.001）。其余 18 例患者随访 38 ± 15 个月，被认为稳定，因为估算肾小球滤过率和蛋白尿没有恶化。在这些患者中，有 7 例（39%）dnDSA 减弱，随访时不再检测到。与 HLA Ⅰ类抗体相比，HLA Ⅱ类抗体的平均荧光强度（MFI）明显较低（2603 ± 1098）（P <.001）。在回归分析中，它们对 dnDSA 减弱有预测作用（P =.043；优势比，0.18；95%置信区间，0.04-0.94）。尽管在随访期间有波动，但那些保留 dnDSA 的患者的 MFI 没有显著变化。
在相当一部分稳定的肾移植患者中，dnDSA 是短暂存在的，尤其是在那些 HLA Ⅰ类抗体和低 MFI 的患者中。多个 dnDSA 和严重蛋白尿对肾移植物的存活率有不利影响。
