HLA类别、钙调神经磷酸酶抑制剂水平与存在供体特异性抗体的肾移植受者的移植失败风险
HLA class, calcineurin inhibitor levels, and the risk of graft failure in kidney recipients with donor-specific antibodies.
作者信息
Béland Marc-Antoine, Lapointe Isabelle, Côté Isabelle, Lesage Julie, Houde Isabelle, Wagner Eric, Riopel Julie, Latulippe Eva, Désy Olivier, De Serres Sacha A
机构信息
Transplantation Unit, Renal Division, Department of Medicine, University Health Center (CHU) of Quebec, Faculty of Medicine, Laval University, Quebec, QC, Canada.
Immunology and Histocompatibility Laboratory, University Health Center (CHU) of Quebec, Faculty of Medicine, Laval University, Quebec, QC, Canada.
出版信息
Front Immunol. 2024 Nov 20;15:1493878. doi: 10.3389/fimmu.2024.1493878. eCollection 2024.
INTRODUCTION
De novo donor-specific HLA antibody (dnDSA) are associated with poor outcomes. Whether this observation applies to both HLA class I and II dnDSA remains unclear.
METHODS
We studied 1236 consecutive kidney recipients who had routine anti-HLA antibody surveillance post-transplant.
RESULTS
During the screening period, 55/1236 (4.4%) patients developed dnDSA: 18 (33%) HLA-I only, 33 (60%) HLA-II only, and 4 (7%) both classes. Thirty patients experienced graft loss at a median of 39 months after dnDSA detection: 9/18 (50%) HLA-I only, 17/33 (52%) HLA-II only, and 4/4 (100%) both classes. A control group was created by matching patients with dnDSA to patients who did not develop DSA and had a functioning graft at the time of dnDSA detection in their respective cases. Compared with these controls, the risk estimates of graft loss were similar between patients with HLA-I only and HLA-II only dnDSA (aHR [95% CI] 2.7 [1.1-6.6], p=0.04 and 3.1 [1.5-6.6], p<0.01 respectively). Additionally, the risk of graft loss decreased with increasing CNI trough levels following dnDSA detection (aHR 0.7 [0.6-0.9] for each increase in 1 ng/mL, p=0.02).
CONCLUSIONS
The prognosis of patients with dnDSA is similar regardless of the HLA class specificity. Lower calcineurin inhibitor levels predict graft loss in such patients.
引言
新发供者特异性HLA抗体（dnDSA）与不良预后相关。这一观察结果是否适用于HLA I类和II类dnDSA尚不清楚。
方法
我们研究了1236例肾移植受者，这些受者在移植后进行了常规抗HLA抗体监测。
结果
在筛查期间，1236例患者中有55例（4.4%）出现dnDSA：仅HLA-I者18例（33%），仅HLA-II者33例（60%），两类均有者4例（7%）。30例患者在检测到dnDSA后中位39个月时出现移植肾丢失：仅HLA-I者9例（50%），仅HLA-II者17例（52%），两类均有者4例（100%）。通过将dnDSA患者与未发生DSA且在各自病例中检测到dnDSA时移植肾功能正常的患者进行匹配，创建了一个对照组。与这些对照组相比，仅HLA-I dnDSA患者和仅HLA-II dnDSA患者移植肾丢失的风险估计相似（校正风险比[aHR][95%可信区间]分别为2.7[1.1-6.6]，p=0.04和3.1[1.5-6.6]，p<0.01）。此外，dnDSA检测后，随着环孢素谷浓度升高，移植肾丢失风险降低（每增加1 ng/mL，aHR为0.7[0.6-0.9]，p=0.02）。
结论
无论HLA类别特异性如何，dnDSA患者的预后相似。较低的钙调神经磷酸酶抑制剂水平预示此类患者移植肾丢失。
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