HLA 相容与不相容肾移植的结局比较：一项全国队列研究。

Comparison of kidney transplant outcomes in HLA compatible and incompatible transplantation: A national cohort study.

作者信息

Rennie Trijntje J W, Battle Richard K, Abel Angela A, McConnell Sylvia, McLaren Robert, Phelan Paul J, Geddes Colin, Padmanabhan Neal, Clancy Marc J, Little Ann-Margaret, Turner David M

机构信息

Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK.

Histocompatibility and Immunogenetics Laboratory, Scottish National Blood Transfusion Service, Royal Infirmary Edinburgh, Edinburgh, UK.

出版信息

Nephrology (Carlton). 2022 Dec;27(12):962-972. doi: 10.1111/nep.14102. Epub 2022 Sep 21.

DOI:10.1111/nep.14102

PMID:36028988

Abstract

BACKGROUND

Reports of HLA incompatible (HLAi) kidney transplant outcomes are inconclusive, especially in the context of lower level Donor Specific Antibodies (DSA).

METHODS

Multi-centre national cohort study of HLAi kidney transplant recipients matched in 1:2 ratio with HLA compatible (HLAc) kidney transplant recipients. HLAi defined as DSA identified by Luminex. Antibody mediated rejection (AMR) and transplant-survival were analysed using Kaplan-Meier plots. Propensity score (PS) matching was used to compare recipient and transplant survival between groups.

RESULTS

We included 61 HLAi and 122 HLAc recipients; mean age 46 years; 60% female. MFI : 3327 (IQR 1352-6458), 23 (38%) were Flow cytometry crossmatch positive (FC-XM ). DSA /FC-XM transplantation carried an increased risk of AMR at 1 year (52%) compared to DSA /FC-XM (27%) and HLAc (0%). Unadjusted death censored graft loss at 3 years was 13% (HLAi) and 8% (HLAc). Three-year patient survival was 95% in HLAc, 84% in DSA /FC-XM and 69% in DSA /FC-XM recipients; 58% of HLAi deaths were infection-related. HLA incompatibility was associated with a decreased 3-year survival in our PS-matched cohort.

CONCLUSION

In kidney transplantation, DSA and positive FC-XM carries an increased risk of AMR. Despite inferior transplant and survival outcomes compared to HLAc transplantation, it remains a realistic option for highly sensitized patients facing prolonged waiting times and reduced survival on dialysis.

摘要

背景

关于HLA不相容（HLAi）肾移植结果的报告尚无定论，尤其是在低水平供者特异性抗体（DSA）的情况下。

方法

对HLAi肾移植受者与HLA相容（HLAc）肾移植受者按1:2比例匹配进行多中心全国队列研究。HLAi定义为通过Luminex鉴定的DSA。使用Kaplan-Meier图分析抗体介导的排斥反应（AMR）和移植存活率。采用倾向评分（PS）匹配来比较组间受者和移植存活率。

结果

我们纳入了61例HLAi受者和122例HLAc受者；平均年龄46岁；60%为女性。平均荧光强度（MFI）：3327（四分位间距1352 - 6458），23例（38%）流式细胞术交叉配型阳性（FC-XM）。与DSA-/FC-XM（27%）和HLAc（0%）相比，DSA+/FC-XM移植在1年时发生AMR的风险增加（52%）。3年时未调整的死亡截尾移植肾丢失率在HLAi组为13%，在HLAc组为8%。HLAc组3年患者生存率为95%，DSA-/FC-XM组为84%，DSA+/FC-XM受者为69%；HLAi受者死亡的58%与感染相关。在我们的PS匹配队列中，HLA不相容与3年生存率降低相关。