Arches Caroline, Usureau Cédric, Anglicheau Dany, Hertig Alexandre, Jalal-Eddine Arwa, Zaidan Mohamad, Taupin Jean-Luc, Snanoudj Renaud
Faculté de Médecine, Sorbonne Universités, Paris, France.
Department of Nephrology-Dialysis-Transplantation, Bicêtre Hospital, Assistance Publique des Hôpitaux de Paris, Le Kremlin-Bicêtre, France.
Transpl Int. 2024 Nov 29;37:13639. doi: 10.3389/ti.2024.13639. eCollection 2024.
Kidney retransplantations are associated with an increased risk of rejection and reduced graft survival compared to first transplantations, notably due to HLA sensitization. The impact of repeated eplet mismatches on retransplantation outcome has not been investigated. We retrospectively assessed the risk of antibody-mediated rejection (ABMR) and graft loss associated with preformed DSA targeting Repeated Eplet MisMatches (DREMM) in sensitized patients undergoing kidney retransplantation. We included 45 retransplanted patients with preformed DSA against the second donor. We determined HLA incompatibilities at the eplet levels, and the eplet target of the DSA using HLAMatchmaker. Repeated mismatches were more frequent at the eplet (87%) than at the antigenic level (22%), but were not associated with the risk of ABMR. The eplet specificity of the DSA revealed that 60% of patients (n = 27) had DREMM. The presence of DREMM was associated with a higher frequency of ABMR (70% versus 28%, = 0.005) and with a lower death-censored graft survival (log-rank test, = 0.01). However, in multivariate Cox model, we could not show that DREMM were associated with the risk of ABMR. In conclusion, this study suggests that identifying DREMM may be an interesting clinical tool, however further larger studies are necessary to precise their exact predictive value.
与首次移植相比，肾再移植与排斥反应风险增加及移植物存活率降低相关，尤其是由于HLA致敏。重复表位错配（eplet mismatches）对再移植结局的影响尚未得到研究。我们回顾性评估了在接受肾再移植的致敏患者中，与靶向重复表位错配（DREMM）的预存供者特异性抗体（DSA）相关的抗体介导排斥反应（ABMR）风险和移植物丢失情况。我们纳入了45例针对第二位供者有预存DSA的再移植患者。我们使用HLAMatchmaker确定了表位水平的HLA不相容性以及DSA的表位靶点。重复错配在表位水平（87%）比在抗原水平（22%）更常见，但与ABMR风险无关。DSA的表位特异性显示60%的患者（n = 27）存在DREMM。DREMM的存在与更高频率的ABMR（70%对28%，P = 0.005）以及更低的死亡校正移植物存活率相关（对数秩检验，P = 0.01）。然而，在多变量Cox模型中，我们未能显示DREMM与ABMR风险相关。总之，本研究提示识别DREMM可能是一种有趣的临床工具，然而需要进一步的大型研究来明确其确切的预测价值。
