Itescu S, Tung T C, Burke E M, Weinberg A, Moazami N, Artrip J H, Suciu-Foca N, Rose E A, Oz M C, Michler R E
Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
Circulation. 1998 Aug 25;98(8):786-93. doi: 10.1161/01.cir.98.8.786.
Preformed anti-HLA antibodies reacting specifically with donor lymphocytes have been associated with acute vascular rejection and early cardiac allograft failure. However, the effect of preformed anti-HLA antibodies directed against allogeneic major histocompatibility complex (MHC) class I or II antigens of a donor panel on heart transplantation outcome has not been extensively studied.
The study group consisted of 68 patients who received cardiac transplants between 1989 and 1996 and who were at high risk for developing anti-HLA antibodies before transplantation. The effect of preformed antibodies against allogeneic MHC class I or class II antigens on the development of early high-grade cellular rejection and on cumulative annual rejection frequency was determined. Both patients with left ventricular assist devices and retransplantation candidates had a similar increase in the frequency of IgG anti-MHC class II antibodies (IgG anti-II) compared with control subjects (P<0.0001), whereas the frequency of IgG anti-MHC class I antibodies (IgG anti-I) was elevated only in patients with left ventricular assist devices. Pretransplantation IgG anti-II predicted early development of high-grade cellular rejection (P=0.006) and higher cumulative annual rejection frequency (P<0.001) in both of these sensitized patient groups. Among retransplantation recipients, a match between donors 1 and 2 at HLA-A additionally predicted an earlier time to a high-grade cellular rejection.
These results emphasize the importance of specifically screening heart transplantation candidates for the presence of IgG antibodies directed against MHC class II molecules and suggest that strategies aimed at their reduction may have an impact on the onset and frequency of high-grade cellular rejections after transplantation.
与供体淋巴细胞特异性反应的预先形成的抗 HLA 抗体与急性血管排斥反应和早期心脏移植失败有关。然而，针对供体组同种异体主要组织相容性复合体（MHC）I 类或 II 类抗原的预先形成的抗 HLA 抗体对心脏移植结果的影响尚未得到广泛研究。
研究组由 68 例在 1989 年至 1996 年间接受心脏移植且移植前有产生抗 HLA 抗体高风险的患者组成。确定了针对同种异体 MHC I 类或 II 类抗原的预先形成的抗体对早期高度细胞排斥反应的发生以及累积年度排斥频率的影响。与对照组相比，接受左心室辅助装置的患者和再次移植候选者的 IgG 抗 MHC II 类抗体（IgG 抗-II）频率均有类似增加（P<0.0001），而 IgG 抗 MHC I 类抗体（IgG 抗-I）频率仅在接受左心室辅助装置的患者中升高。移植前 IgG 抗-II 预测了这两个致敏患者组中早期高度细胞排斥反应的发生（P=0.006）和更高的累积年度排斥频率（P<0.001）。在再次移植受者中，供体 1 和 2 在 HLA-A 位点的匹配还预测了高度细胞排斥反应出现的时间更早。
这些结果强调了专门筛查心脏移植候选者中针对 MHC II 类分子的 IgG 抗体的重要性，并表明旨在降低这些抗体的策略可能会对移植后高度细胞排斥反应的发生和频率产生影响。
