肾移植术后非HLA抗体特征与移植肾病理状态的相关性分析

Analysis of correlation between non-HLA antibody characteristics and pathological status of renal graft

目的探讨肾移植术后受者非人类白细胞抗原(human leukocyte antigen,HLA)抗体特征及其与移植肾病理状态的关系。方法回顾性分析2016—2022年444例肾脏移植术后受者非HLA抗体检测资料,根据移植肾病理诊断结果分为排斥反应组(47例)、非排斥反应组(61例)、肾功能稳定组(336例)。应用Graph Pad Prism 9.0统计软件,分析肾脏移植术后非HLA抗体的特征,非HLA抗体与HLA抗体的相关性,非HLA抗体与移植肾病理状态的关系。结果444例受者中,非HLA抗体阳性为69.8%(310例),与HLA抗体呈正相关关系(r=0.606,P<0.001),术后HLA抗体阳性受者非HLA抗体中位MFI值及和阈值的中位倍数高于HLA抗体阴性患者。排斥反应组,非排斥反应组及肾功能稳定组之间常见非HLA抗体存在差异。非HLA抗体与慢性肾小球病变(r=0.186,P=0.033),间质纤维化(r=0.265,P=0.002)呈正相关关系。受试者工作特征曲线(receiver operating characteristic curve,ROC)分析发现,非HLA抗体预测移植肾动脉炎(AUC=0.771)和慢性肾小球病变(AUC=0.741)诊断价值较高,但是预测排斥反应的能力不强(AUC=0.605)。结论肾移植术后非HLA抗体阳性率较高。排斥反应、非排斥反应及移植肾功能稳定受者常见非HLA抗体不同。非HLA抗体与移植肾慢性病变关系密切,并且对移植肾动脉炎和移植肾慢性病变的预测价值高于对排斥反应的预测价值。

Objective To investigate non-HLA antibodies characteristics and its relationship with graft pathology after renal transplantation.Methods Non-HLA antibody data of 444 recipients after renal transplantation from 2016 to 2022 were retrospectively analyzed,the recipients were divided into rejection group(47 cases),non-rejection group(61 cases),and stable renal function group(336 cases)according to the pathological diagnosis of grafts.GraphPad Prism 9.0 was used to analyze the characteristics of non-HLA antibodies after kidney transplantation,the correlation between non-HLA antibodies and HLA antibodies,and the relationship between non-HLA antibodies and the pathological state of the renal allograft.Results Among the 444 recipients,310 cases(69.8%)were positive for non-HLA antibodies,which was positively correlated with HLA antibodies(r=0.606,P<0.001).The median of MFI value and the median multiple of the threshold value of non-HLA antibodies in recipients with positive HLA antibodies was higher than that in recipients with negative HLA antibodies post-transplant.There were differences in common non-HLA antibodies among rejection group,non-rejection group and renal function stable group.Non-HLA antibodies were positively correlated with chronic glomerulopathy(r=0.186,P=0.033)and interstitial fibrosis(r=0.265,P=0.002).Receiver operating characteristic curve(ROC)analysis showed that non-HLA antibodies were highly predictive of allograft arteritis(AUC=0.771)and chronic nephropathy(AUC=0.741),but were not good at predicting rejection(AUC=0.605).Conclusion The positive rate of non-HLA antibodies was higher after renal transplantation.The common non-HLA antibodies in recipients with rejection,non-rejection and stable renal allograft function are different.Non-HLA antibodies are closely related to the chronic disease of graft kidney,and their predictive value for graft arteritis and chronic graft nephropathy is higher than that for rejection.