基于Eplet及EMS配型预测新生DSA介导的急性排斥反应发生风险的研究

Predicting the risk of dn DSA-mediated acute rejection based upon Eplet and EMS matching

目的比较人类白细胞抗原(HLA)错配数及不同类型错配评分预测肾移植术后发生新生供者特异性抗体(DSA)介导的急性排斥反应风险的效力。方法回顾性分析2018年7月至2020年4月期间上海交通大学医学院附属仁济医院174例肾移植受者及其供者的HLA高分辨配型错配数、Eplet错配评分及EMS错配评分。174例受者中,13例术后发生新生DSA介导的急性排斥反应受者作为研究组,161例肾移植术后新生DSA阴性受者作为对照组。结合临床数据,分别评估三种方案预测肾移植术后发生新生DSA介导的急性排斥反应风险的效力。结果研究组与对照组相比,HLA配型错配数差异无统计学意义(6.90和6.65,P=0.5824);Total Eplet错配数差异无统计学意义(45.78和36.47,P=0.0876),Abver Eplet错配数差异存在统计学意义(23.33和17.07,P<0.05);研究组与对照组相比,针对HLA-A的EMS评分(15.06和9.73,P=0.0425)、HLA-B的EMS评分(16.53和8.06,P=0.0468)、HLA-DQ的EMS评分(22.30和17.96,P=0.0204)差异有统计学意义,针对HLA-DR的EMS评分(23.99和13.85,P=0.1356)差异无统计学意义。结论Abver Eplet错配评分及针对单个HLA位点的EMS错配评分能更好的预测肾移植术后发生新生DSA介导的急性排斥反应风险。

Objective To compare the effectiveness of human leukocyte antigen(HLA)matching and different kinds of mismatch score in predicting the risk of neonatal donor-specific antibody mediated acute rejection after kidney transplantation.Methods Retrospective analysis was performed for the number of HLA high-resolution mismatches,Eplet mismatch scores and EMS mismatch scores in 174 donors and recipients.The study group was composed of 13 recipients with dn DSA-mediated acute rejection while the control group included 161 recipients with negative dn DSA.In conjunctions with clinical data,the effectiveness of three schemes in predicting the risk of dn DSA-mediated acute rejection after kidney transplantation was evaluated.Results No significant inter-group statistical difference existed in the number of HLA mismatches(6.90 and 6.65,P=0.5824)or total Eplet(45.78 and 36.47,P=0.0876).There were significant inter-group statistical differences in the number of mismatches in Abver Eplet(23.33 and 17.07,P<0.05)and EMS scores for HLA-A(15.06 and 9.73,P=0.0425),HLA-B(16.53 and 8.06,P=0.0468)and HLA-DQ(22.30 and 17.96,P=0.0204).There was no statistical difference in HLA-DR EMS score(23.99 and 13.85,P=0.1356).Conclusions Abver Eplet and EMS mismatch scoreS for a single HLA site can better predict the risk of dn DSA-mediated acute rejection after kidney transplantation.