Acute Antibody-Mediated Rejection in Living ABO-Incompatible Kidney Transplantation: Long-Term Impact and Risk Factors
Acute Antibody-Mediated Rejection in Living ABO-Incompatible Kidney Transplantation: Long-Term Impact and Risk Factors
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DOI：
10.1111/j.1600-6143.2008.02538.x
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发表时间：
2009-03-01
影响因子：
8.8
通讯作者：
Tanabe, K.
中科院分区：
文献类型：
--
作者：
Toki, D.;Ishida, H.;Tanabe, K.
急性抗体介导的排斥反应（AAMR）对ABO血型不合（ABOI）肾移植长期结局的影响尚未完全了解。我们回顾性分析了1999年至2004年期间进行的57例连续接受AAMR的患者的AAMR的长期影响和AAMR的危险因素。移植后3个月内发生AAMR的19例患者（33%）构成AMR组。AMR组的移植物存活率显著较低（分别为AMR与非AMR; 5年：84%与95%; 8年：45%与95%; p = 0.009）。移植后1年移植肾小球病的患病率在AMR组中显著更高（AMR组64% vs.非AMR组3%，p < 0.001）。多变量分析表明，移植时抗血型IgG抗体滴度为1：32（OR，9.52; p = 0.041）和Luminex单珠法检测到的供体特异性抗HLA抗体（DSHA）（OR，5.68; p = 0.015）是AAMR的独立风险因素，无论基线抗血型IgG抗体滴度如何。我们的研究结果表明，AAMR对长期结果有很大的影响，术前DSHA似乎比抗血型抗体与移植物预后不良有更显著的相关性，即使在ABOI肾移植中也是如此。
The impact of acute antibody-mediated rejection (AAMR) on the long-term outcome on ABO-incompatible (ABOI) kidney transplantation is not well understood. We retrospectively analyzed the long-term impact of AAMR and risk factors for AAMR in 57 consecutive recipients performed between 1999 and 2004. Nineteen patients (33%) who developed AAMR within 3 months posttransplantation constituted of the AMR group. The graft survival rate was significantly lower in the AMR group (AMR vs. non-AMR, respectively; 5 years: 84% vs. 95%; 8 years: 45% vs. 95%; p = 0.009). The prevalence of transplant glomerulopathy at 1 year posttransplantation was significantly higher in the AMR group (AMR 64% vs. non-AMR 3%, p < 0.001). Multivariate analysis demonstrated that anti-blood group IgG antibody titers of 1:32 at the time of transplantation (OR, 9.52; p = 0.041) and donor-specific anti-HLA antibodies (DSHA) detected by Luminex single bead method (OR, 5.68; p = 0.015) were independent risk factors for AAMR regardless of baseline anti-blood group IgG antibody titers. Our results indicate that AAMR has a heavy impact on the long-term outcome and preoperative DSHA appears to have a more significant association with poor graft outcomes than anti-blood group antibodies, even in ABOI kidney transplantation.