ten Hoor G M, Coopmans M, Allebes W A
Laboratory for Transplantation Serology, Radboud University Hospital, Nijmegen, The Netherlands.
Transplantation. 1993 Aug;56(2):298-304. doi: 10.1097/00007890-199308000-00008.
Sixty-five kidney transplantations performed across a non-current alloantibody-positive T cell crossmatch or an alloantibody-positive B cell crossmatch were studied retrospectively. The DTT crossmatch was used to discriminate between IgM and IgG donor-reactive antibodies. Subsequently the HLA specificity of donor-reactive IgG antibodies was determined in the MAILA assay. The first transplantations performed across a non-current positive T cell DTT crossmatch (IgG) were associated with poor graft survival, as only 5 of 11 (45%) transplants were functioning at 1 year. The HLA specificity of donor T cell reactive IgG antibodies appeared to determine the fate of the graft: only 2 of 7 (29%) patients with donor HLA class I-reactive antibodies had functioning grafts at 1 year, whereas all 3 patients with donor T cell-reactive antibodies, lacking HLA specificity, had functioning grafts. In 17 first transplantations, 15 grafts (88%) transplanted across an IgM-positive B cell crossmatch were functioning at 1 year. In 9 re-transplantations we found 6 grafts (67%) functioning at 1 year. B cell-reactive IgG antibodies, however, were associated with poor graft survival. In 7 first transplantations 2 grafts (29%) were functioning at 1 year, and in 17 re-transplantations 8 grafts (47%) were functioning at 1 year. For 19 patients the HLA specificity of donor B cell-reactive IgG antibodies was determined. Thirteen patients had HLA class II (-DR and/or -DQ)--specific antibodies; of these, 4 (31%) had a functioning graft at 1 year. Two of 3 (67%) patients with weak HLA class I--reactive antibodies and 2 of 3 (67%) patients with B cell--reactive IgG antibodies without HLA specificity had a functioning graft at 1 year. Although the number of cases analyzed is small, the following conclusions can be drawn: First, in general, the presence of donor HLA class I-, HLA-DR-, and HLA-DQ-reactive IgG antibodies is a contraindication to transplantation. However, under certain so-far-unknown conditions, transplantation across donor-reactive HLA specific IgG alloantibodies might be possible. Second, renal transplantation can be safely performed across B cell-reactive IgM antibodies. Third, donor-reactive IgG antibodies that do not recognize HLA do not seem to be harmful.
我们对65例在当前非阳性的同种异体抗体阳性T细胞交叉配型或同种异体抗体阳性B细胞交叉配型情况下进行的肾移植进行了回顾性研究。使用二硫苏糖醇（DTT）交叉配型来区分IgM和IgG供体反应性抗体。随后，在MAILA试验中确定供体反应性IgG抗体的HLA特异性。首次在当前非阳性的T细胞DTT交叉配型（IgG）情况下进行的移植与移植物存活率低相关，因为11例移植中只有5例（45%）在1年后仍有功能。供体T细胞反应性IgG抗体的HLA特异性似乎决定了移植物的命运：在1年后，7例有供体HLA I类反应性抗体的患者中只有2例（29%）移植物有功能，而3例有供体T细胞反应性抗体但缺乏HLA特异性的患者的移植物均有功能。在17例首次移植中，15例（88%）在IgM阳性B细胞交叉配型情况下进行移植的移植物在1年后仍有功能。在9例再次移植中，我们发现6例（67%）移植物在1年后仍有功能。然而，B细胞反应性IgG抗体与移植物存活率低相关。在7例首次移植中，2例（29%）移植物在1年后仍有功能，在17例再次移植中，8例（47%）移植物在1年后仍有功能。我们确定了19例患者供体B细胞反应性IgG抗体的HLA特异性。13例患者有HLA II类（-DR和/或-DQ）特异性抗体；其中4例（31%）在1年后移植物有功能。3例有弱HLA I类反应性抗体的患者中有2例（67%）以及3例有B细胞反应性IgG抗体但无HLA特异性的患者中有2例（67%）在1年后移植物有功能。尽管分析的病例数较少，但可以得出以下结论：第一，一般来说，存在供体HLA I类、HLA-DR和HLA-DQ反应性IgG抗体是移植的禁忌证。然而，在某些目前尚不清楚的情况下，跨越供体反应性HLA特异性IgG同种异体抗体进行移植可能是可行的。第二，肾移植可以安全地在B细胞反应性IgM抗体情况下进行。第三，不识别HLA的供体反应性IgG抗体似乎无害。
