Noble Johan, Dard Céline, Giovannini Diane, Naciri Bennani Hamza, Fournier Pierre, Bardy Béatrice, Bourdin Anne, Imerzoukene Farida, Motte Lionel, Terrec Florian, Malvezzi Paolo, Jouve Thomas, Rostaing Lionel
Nephrology, Hemodialysis, Apheresis and Kidney Transplantation Department, Grenoble University Hospital, Grenoble, France.
Univ. Grenoble Alpes, Grenoble, France.
Front Immunol. 2025 Jun 23;16:1612462. doi: 10.3389/fimmu.2025.1612462. eCollection 2025.
Kidney transplant (KT) candidates with very high calculated panel reactive alloantibody (cPRA >95%) have limited chances to receive an HLA-matched transplant unless they undergo pretransplant desensitization.
To assess the efficacy of immunoadsorption (IA) in desensitizing pretransplant KT candidates with high cPRA and positive crossmatch.
This was a single-center retrospective cohort study involving highly HLA-sensitized patients (cPRA >85%). Forty-nine patients underwent HLA-incompatible (HLAi) KT, of whom 25 (51%) received kidneys from deceased donors. Of these 49 patients, 23 had either a positive complement-dependent cytotoxic cross-match (CDC) and/or a positive flow cytometry cross-match (FCM). The remaining 26 patients had donor-specific anti-HLA (DSAs) detectable only by Luminex (CDC and FCM cross-matches were negative). Only CDC-positive and FCM-positive patients were desensitized. These 49 patients were compared with 160 patients who had cPRA >85% but underwent HLA-compatible (HLAc) KT, i.e., without pretransplant DSAs.Pretransplant desensitization included IA sessions, rituximab, tacrolimus, steroids, and mycophenolate mofetil. Induction therapy consisted of antithymocyte globulins.
The mean follow-up duration was 7.4 ± 4 years. At 1-year and at last follow-up, 43 patient and death-censored graft survival rates were similar between HLAc and HLAi patients. However, HLAi patients experienced significantly more biopsy-proven rejections compared to HLAc patients. These rejections were predominantly antibody-mediated. Finally, the rate of infectious complications was similar between HLAc and HLAi patients.
IA in addition to immunosuppression is an effective option for desensitizing HLAi patients, yielding favorable long-term outcomes.
计算得出的群体反应性抗体（cPRA）非常高（cPRA>95%）的肾移植（KT）候选者接受HLA匹配移植的机会有限，除非他们在移植前进行脱敏治疗。
评估免疫吸附（IA）对移植前cPRA高且交叉配型阳性的KT候选者进行脱敏治疗的疗效。
这是一项单中心回顾性队列研究，纳入了高HLA致敏患者（cPRA>85%）。49例患者接受了HLA不相合（HLAi）肾移植，其中25例（51%）接受了来自 deceased 供体的肾脏。在这49例患者中，23例补体依赖细胞毒性交叉配型（CDC）和/或流式细胞术交叉配型（FCM）呈阳性。其余26例患者仅通过Luminex检测到供体特异性抗HLA（DSA）（CDC和FCM交叉配型均为阴性）。仅对CDC阳性和FCM阳性患者进行脱敏治疗。将这49例患者与160例cPRA>85%但接受HLA相合（HLAc）肾移植的患者进行比较，即移植前无DSA。移植前脱敏治疗包括IA疗程、利妥昔单抗、他克莫司、类固醇和霉酚酸酯。诱导治疗包括抗胸腺细胞球蛋白。
平均随访时间为7.4±4年。在1年时和最后一次随访时，HLAc和HLAi患者的43例患者和死亡截尾移植物存活率相似。然而，与HLAc患者相比，HLAi患者经活检证实的排斥反应明显更多。这些排斥反应主要是抗体介导的。最后，HLAc和HLAi患者的感染并发症发生率相似。
IA联合免疫抑制是使HLAi患者脱敏的有效选择，可产生良好的长期结果。
