Delmonico F L, Fuller A, Cosimi A B, Tolkoff-Rubin N, Russell P S, Rodey G E, Fuller T C
Transplantation. 1983 Dec;36(6):629-33. doi: 10.1097/00007890-198336060-00007.
A class I HLA molecule may bear not only a private or unique determinant, but a shared, yet discrete, public epitope. These public determinants occur with a much higher frequency in the random donor population than the associated private determinants--and thus, are encountered more often in random donor blood transfusions and in renal transplantation. Sera from highly sensitized dialysis patients have been reported to contain a restricted number of antibodies to public determinants rather than a diverse array of antibodies directed against the private HLA-AB epitopes. As detailed in this report, comprehensive serum analysis of the public antibodies in highly sensitized transplant candidates has optimized identification of potential crossmatch-compatible donors and has avoided needless crossmatches. During the past two years, the incidence of renal transplantation from cadaveric donors to highly sensitized recipients has doubled at this institution. At 10-25 months following transplantation, 70% of these allografts are functioning. Private HLA class I antigen incompatibility was not a barometer for exclusion in the final donor crossmatch of these highly sensitized recipients. Furthermore, positive donor T cell crossmatches with sera obtained more than six months prior to transplantation may not represent an impediment to successful transplantation. We conclude that the approach of detailed antibody analysis can result in an improved outlook for successful transplantation of more dialysis patients who are highly sensitized to the class I HLA alloantigens.
I类HLA分子不仅可能带有一个个体特异性或独特的决定簇，还可能带有一个共享但又离散的公共表位。这些公共决定簇在随机供者群体中出现的频率比相关的个体特异性决定簇高得多——因此，在随机供者输血和肾移植中更常遇到。据报道，高度致敏的透析患者的血清中含有数量有限的针对公共决定簇的抗体，而不是针对个体HLA-AB表位的多种抗体。如本报告所述，对高度致敏的移植候选者的公共抗体进行全面血清分析，优化了潜在交叉配型相容供者的识别，并避免了不必要的交叉配型。在过去两年中，该机构从尸体供者到高度致敏受者的肾移植发生率翻了一番。移植后10 - 25个月，这些同种异体移植物中有70%仍在发挥功能。在这些高度致敏受者的最终供者交叉配型中，个体I类HLA抗原不相容并不是排除的指标。此外，移植前六个月以上获得的血清与供者T细胞交叉配型呈阳性，可能并不妨碍移植成功。我们得出结论，详细抗体分析的方法可以改善更多对I类HLA同种抗原高度致敏的透析患者成功移植的前景。
