Karolak Wojtek, Dukat-Mazurek Anna, Woźniak-Grygiel Elżbieta, Łącka Monika, Wojarski Jacek, Moszkowska Grażyna, Dębska-Zielkowska Joanna, Zielińska Hanna, Łukaszewska Joanna, Sharma Naivedya, Lango-Maziarz Anna, Maruszewski Marcin, Żegleń Sławomir
Department of Cardiac Surgery and Vascular Surgery, Medical University of Gdansk, Mariana Smoluchowskiego 17, 80-214 Gdańsk, Poland.
Department of Clinical Immunology and Transplantology, Medical University of Gdansk, Dębinki 7, 80-211 Gdańsk, Poland; Immunology & Transplantology Clinical Laboratory, University Laboratory Medicine Centre, University Clinical Center in Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland.
Transpl Immunol. 2022 Apr;71:101553. doi: 10.1016/j.trim.2022.101553. Epub 2022 Feb 12.
For lung transplantation, the presence of donor-specific anti-HLA antibodies (DSA) is an important factor of antibody-mediated rejection (AMR) in its hyperacute, acute or chronic form during long-term follow up. The aim of the study was to assess the allosensitization of Polish patients qualified for a lung transplantation in our center. A retrospective study of 161 potential lung allograft recipients, also of 31 patients transplanted in the University Hospital of Gdansk, between June 2018 and December 2020 were performed. 121 potential recipients were thoroughly tested for immunization status before eventual lung transplantation. SAB-testing, PRA-CDC and vPRA assessment, and HLA typing were performed to guide donor-recipient matching and risk stratification. Then 73 patients were separated and qualified for the list of patients awaiting lung transplantation. Then 31 patients were transplanted based on a negative biological crossmatch result. The patients were generally not sensitized, as the median PRA-CDC was 0% (min 0; max 53), and the vPRA, calculated according to HLA ABDR (>2000 cut-off MFI), was 8% (min 0; max 99). If the cut-off was split into 2000 MFI for HLA ABDR, 10,000 MFI for HLAC, and 7000 MFI for HLA-DQ, the vPRA increased to 20% (min 0; max 99). The immunization status was assessed with single antigen-SAB assays. For class I, the number of any detectable alloantibodies was 14 (11.6%) 21 (17.35%) 16 (13.22%) for locus HLA-A/B/C, and 28 (23.14%) 30 (24.8%) 24 (19.8%) for locus HLA-DR/DQ/DP, respectively. The immunization of the transplanted patients was then analyzed in detail. Summarizing, the study is an analysis of the degree of anti-HLA immunization in the population of patients eligible for lung transplantation, which showed that this degree is of low intensity and can be effectively and safely and very precisely diagnosed before transplantation.
对于肺移植而言，供者特异性抗人白细胞抗原（HLA）抗体（DSA）的存在是长期随访期间超急性、急性或慢性抗体介导排斥反应（AMR）的一个重要因素。本研究的目的是评估在我们中心符合肺移植条件的波兰患者的致敏情况。对2018年6月至2020年12月期间161名潜在肺移植受者以及格但斯克大学医院的31名已接受移植的患者进行了回顾性研究。121名潜在受者在最终肺移植前接受了全面的免疫状态检测。进行了固相抗体（SAB）检测、群体反应性抗体补体依赖细胞毒试验（PRA-CDC）和虚拟群体反应性抗体（vPRA）评估以及HLA分型，以指导供受者匹配和风险分层。然后73名患者被筛选出来并符合等待肺移植患者名单的条件。随后31名患者基于阴性生物学交叉配型结果接受了移植。患者总体上未致敏，群体反应性抗体补体依赖细胞毒试验（PRA-CDC）的中位数为0%（最小值0；最大值53），根据HLA ABDR（截断值>2000平均荧光强度）计算的虚拟群体反应性抗体（vPRA）为8%（最小值0；最大值99）。如果将截断值分为HLA ABDR为2000平均荧光强度、HLA C为10000平均荧光强度以及HLA-DQ为7000平均荧光强度，则虚拟群体反应性抗体（vPRA）增加至20%（最小值0；最大值99）。通过单抗原固相抗体（SAB）检测评估免疫状态。对于I类，在HLA-A/B/C位点，任何可检测到的同种抗体数量分别为14例（11.6%）、21例（17.35%）、16例（13.22%），在HLA-DR/DQ/DP位点分别为28例（23.14%）、30例（24.8%）、24例（19.8%）。随后对已移植患者的免疫情况进行了详细分析。总之，本研究分析了符合肺移植条件患者群体中的抗HLA免疫程度，结果表明该程度强度较低，并且在移植前能够有效、安全且非常精确地进行诊断。
