Increased C4d in post-reperfusion biopsies and increased donor specific antibodies at one-week post transplant are risk factors for acute rejection in mild to moderately sensitized kidney transplant recipients
Increased C4d in post-reperfusion biopsies and increased donor specific antibodies at one-week post transplant are risk factors for acute rejection in mild to moderately sensitized kidney transplant recipients
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DOI：
10.1038/ki.2013.44
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发表时间：
2013-06-01
影响因子：
19.6
通讯作者：
Foley, David P.
中科院分区：
文献类型：
--
作者：
Djamali, Arjang;Muth, Brenda L.;Foley, David P.
为了确定免疫抑制的强度，我们检查了脱敏方案中急性排斥反应的风险因素，该方案使用基线供体特异性抗体水平作为平均荧光强度（MFImax）。该研究纳入了146例负血流交叉配型移植患者，平均随访18个月，其中大多数（83%）至少随访1年。在移植时，在低风险和高风险方案之间，平均计算的群体反应性抗体和MFImax的范围分别为10.3-57.2%和262-1691。从移植到1周和1年，平均MFImax显著增加。急性排斥反应（平均1.65个月）的发生率为32%，包括14%的细胞，12%的抗体介导的，和6%的混合性排斥反应的临床和亚临床排斥反应的组合。在回归分析中，只有再灌注后活检中的C4d染色（风险比3.3，置信区间1.71-6.45）和移植后1周特异性抗体增加是排斥反应的重要预测因素。MFImax增加500与2.8倍的排斥风险相关。因此，再灌注后活检中的C4d染色和移植后供体特异性抗体的早期升高是中度致敏患者排斥反应的风险因素。
In order to define the intensity of immunosuppression, we examined risk factors for acute rejection in desensitization protocols that use baseline donor-specific antibody levels measured as mean fluorescence intensity (MFImax). The study included 146 patients transplanted with a negative flow crossmatch and a mean follow-up of 18 months with the majority (83%) followed for at least 1 year. At the time of transplant, mean-calculated panel-reactive antibody and MFImax ranged from 10.3-57.2% and 262-1691, respectively, between low-and high-risk protocols. Mean MFImax increased significantly from transplant to 1 week and 1 year. The incidence of acute rejection (mean 1.65 months) as a combination of clinical and subclinical rejection was 32%, including 14% cellular, 12% antibody-mediated, and 6% mixed rejection. In regression analyses, only C4d staining in post-reperfusion biopsies (hazard ratio 3.3, confidence interval 1.71-6.45) and increased specific antibodies at 1-week post transplant were significant predictors of rejection. A rise in MFImax by 500 was associated with a 2.8-fold risk of rejection. Thus, C4d staining in post-reperfusion biopsies and an early rise in donor specific antibodies after transplantation are risk factors for rejection in moderately sensitized patients.