抗供者特异性抗体对致敏肾移植受者的临床意义

Clinical significance of donor-specific anti-HLA antibodies for sensitized renal transplantation recipients

背景:应用灵敏的技术可以检测到致敏肾移植患者体内低水平抗体,但是即便如此临床上依然无法完全检测出全部抗体。目的:探讨抗供者特异性抗体对致敏肾移植受者的临床意义及其在预测排斥反应中的作用。方法:肾移植术前常规检测补体依赖淋巴细胞毒试验和群体反应性抗体,群体反应性抗体阳性者(PRA≥10%)检测抗供者特异性抗体,其术后临床结果与抗供者特异性抗体阴性患者做比较。结果与结论:在379例接受肾移植的患者中,55例患者的群体反应性抗体≥10%,这些患者中75%曾有过致敏史。其中20例检测出抗供者特异性抗体,这些阳性患者肾移植术后更易发生急性排斥反应,移植肾功能恢复延迟和移植肾存活率低下等。结果提示抗供者特异性抗体的存在与移植物失功、排斥反应有显著相关性。而体内仅存非抗供者特异性抗体的患者移植效果相对好。对于淋巴细胞毒试验阴性但体内抗供者特异性抗体阳性的肾移植患者,术后需要更积极地监测免疫功能和调整免疫抑制方案。

BACKGROUND：Sensitive techniques are able to detect low levels of circulating antibodies.However,clinical consequences of these antibodies still unknown.OBJECTIVE：To investigate the clinical significance of donor-specific anti-HLA antibodies（DSA） for sensitized renal transplantation recipients and it role in predicting early rejection after kidney transplantation.METHODS：Patients who received kidney transplantation were tested for pre-transplant complement-dependent cytotoxicity（CDC） crossmatches and panel reactive antibodies（PRA）.Patients were considered to have circulating antibodies if PRA was equal to or greater than 10%.These patients were then analyzed for DSA.Clinical outcomes were compared in patients with and without DSAs.RESULTS AND CONCLUSION：In a total of 379 patients who underwent transplantation,55 had PRA equal to or greater than 10%.Of these 55 patients,75% had a history of a sensitizing event.Twenty out of 55 patients were DSA＋.Patients with DSA detected by ELISA had higher rates of delayed graft function,acute rejection,and lower rates of graft survival.The detection of DSA was associated with significantly higher rates of graft dysfunction and immunological events.Conversely,the presence of antibodies but no DSA was associated with excellent outcomes.In patients with negative CDC crossmatches,the occurrence of low-level DSA could assist in identifying patients that require more aggressive immune monitoring or immunosuppressive strategies.