The Clinical Spectrum of De Novo Donor-Specific Antibodies in Pediatric Renal Transplant Recipients
The Clinical Spectrum of De Novo Donor-Specific Antibodies in Pediatric Renal Transplant Recipients
复制标题
DOI：
10.1111/ajt.12859
复制
发表时间：
2014-10-01
影响因子：
8.8
通讯作者：
Marks, S. D.
中科院分区：
文献类型：
--
作者：
Kim, J. J.;Balasubramanian, R.;Marks, S. D.
供者特异性HLA抗体（DSA）的产生与成人患者肾移植存活率降低相关。本研究评估了新生DSA的自然史及其对儿童肾移植受者（RTR）肾功能的影响。在移植后1、3、6和12个月，随后每隔12个月和移植物功能障碍期间，使用单抗原珠检测法前瞻性地测量HLA抗体。在215例HLA抗体监测的患者中，75例（35%）在移植后中位数0.25年发生DSA，II类（70%）和HLA-DQ（45%）DSA的患病率较高。35例（47%）患者的DSA消退，与早期检测（中位数，四分位数间距0.14，0.09-0.33 vs. 0.84，0.15-2.37年）和较低的平均荧光强度（MFI）（2658，1573-3819 vs. 7820，5166-11 990）相关。总体而言，DSA阳性患者的GFR下降更快，平均5.3（CI：4.7-5.8）年时GFR下降50%，而DSA阴性患者为6.1（5.7-6.4）年（p=0.02）。II级DSA MFI每增加1个log 10，GFR降低1 mL/min/1.73 m2（p
The development of donor-specific HLA antibodies (DSA) is associated with worse renal allograft survival in adult patients. This study assessed the natural history of de novo DSA, and its impact on renal function in pediatric renal transplant recipients (RTR). HLA antibodies were measured prospectively using single-antigen-bead assays at 1, 3, 6 and 12 months posttransplant followed by 12-monthly intervals and during episodes of allograft dysfunction. Of 215 patients with HLA antibody monitoring, 75 (35%) developed DSA at median of 0.25 years posttransplant with a high prevalence of Class II (70%) and HLA-DQ (45%) DSA. DSA resolved in 35 (47%) patients and was associated with earlier detection (median, inter-quartile range 0.14, 0.09-0.33 vs. 0.84, 0.15-2.37 years) and lower mean fluorescence intensity (MFI) (2658, 1573-3819 vs. 7820, 5166-11 990). Overall, DSA positive patients had more rapid GFR decline with a 50% reduction in GFR at mean 5.3 (CI: 4.7-5.8) years versus 6.1 (5.7-6.4) years in DSA negative patients (p=0.02). GFR decreased by a magnitude of 1mL/min/1.73m(2) per log10 increase in Class II DSA MFI (p