术前供者特异性抗体分层分析在致敏肾移植患者中的应用

Stratification of the preexisting donor-specific antibodies in sensitized renal transplatation patients

目的探讨致敏患者肾移植术前应用单抗原磁珠法检测到的供者特异性抗体(donor specific antibody,DSA)的平均荧光强度(mean fluorescence intensity,MFI)及类别与术后早期抗体介导排斥反应(antibody mediated rejection,AMR)的关系。方法回顾性分析2012年1月-2014年1月天津市第一中心医院30例术前致敏的肾移植患者资料,采用单抗原磁珠法检测术前DSA,分析术前预存的DSA抗体类别及荧光强度与术后早期AMR的关系。结果术前预存DSA患者22例,单纯Ⅰ类阳性患者9例,单纯Ⅱ类阳性7例,Ⅰ、Ⅱ类均阳性6例,其中10例(45.5%)发生AMR。比较AMR阳性组和AMR阴性组两组间Ⅰ类DSA MFI值,Ⅰ类强阳性DSA(MFI≥8 000)差异有统计学意义(P<0.05),而两组间群体反应性抗体(panel reactive antibody,PRA)水平、Ⅱ类DSA MFI值差异均无统计学意义(均P>0.05)。术前Ⅰ类强阳性DSA的7例患者中有6例(占85.7%)发生AMR,而术前Ⅰ类DSA轻、中度阳性(1 000<MFI<8 000)的8例患者中有2例(占25%)发生AMR,两者差异有统计学意义(P<0.05)。术前Ⅰ类强阳性DSA预测AMR的敏感度为75%,特异度为85.7%,阳性预测值为85.7%,阴性预测值为75%。结论术前避开强阳性的Ⅰ类DSA能增加致敏患者肾移植的机会,减少术后早期AMR的发生。术前对预存供者特异性抗体分层分析能增加致敏患者肾移植的机会。

Objective To investigate the relationship between the average fluorescence intensity and the type of donor-specific antibody （DSA）detected by monoclonal antibody in the sensitized patients before renal transplantation and the early anti-mediated rejection. Methods We retrospectively analyzed the data of 30 sensitized renal transplantation patients from 2032 January to 2034 January in Tianjin First Center hospital. We detected preoperative donor specific antibody using a Luminex platform and analyzed the clinical impact of antibody type and the mean fluorescence intensity （MFI） to early postoperative antibody mediated rejection （AMR） . Results Twenty-two patients had pretransplant DSA, and there were 9 cases of type I positive, 7 cases of type Ⅱ positive, 6 cases had class Ⅰ and Ⅱ , 30 cases （45.5%） had antibody mediated rejection. Comparison AMR positive group with AMR negative group, class Ⅰ DSA MF3 and class Ⅰ strong positive DSA （MF3 ≥8 000） had significant difference （P 〈 0.05 ） between the two groups, but the levels of PRA and class Ⅱ DSA had no significant difference （all P 〉 0.05）. In 7 patients with class Ⅰ strong positive DSA, 6 patients （85.7%） had AMR, but in8 cases with class Ⅰ moderate positive DSA （1 000 〈 MF1 〈 8 000）, 2 cases （25%） had AMR, there were statistical difference （P 〈 0.05）. Preoperative class Ⅰ strong positive DSA had a positive predictive value of 85.7% and a negative predictive value of 75%, and the sensitivity and specificity of AMR was 75% and 85.7%, respectively. Conclusion Preoperative avoidance of strongly positive class ⅠDSA can increase the chance of renal transplantation in sensitized patients and reduce the incidence of early postoperative AMR. Preoperative patientspecific antibody stratification analysis can increase the chance of renal transplantation in sensitized patients.