Alloantibody Levels and Acute Humoral Rejection Early After Positive Crossmatch Kidney Transplantation
Alloantibody Levels and Acute Humoral Rejection Early After Positive Crossmatch Kidney Transplantation
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DOI：
10.1111/j.1600-6143.2008.02441.x
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发表时间：
2008-12-01
影响因子：
8.8
通讯作者：
Stegall, M. D.
中科院分区：
文献类型：
--
作者：
Bums, J. M.;Comell, L. D.;Stegall, M. D.
我们在两组交叉配型阳性（+XM）肾移植受者中检查了移植后早期供体特异性同种抗体（DSA）水平的变化及其与急性体液排斥反应（AHR）的关系：高DSA组-41名接受者具有基线T细胞或B细胞血流交叉配型（TFXM，BFXM）通道偏移>= 300（等效可溶性荧光色素单位（MESF）分子约为19 300），接受了移植前血浆置换术（PP），低DSA组：29例基线通道移位< 300，未行PP。高DSA组AHR发生率为39%（16/41），低DSA组为31%（9/29）。总的来说，平均DSA水平在移植后第4天下降，并且在未发生AHR的患者中保持较低水平。到第10天，发生AHR的患者的DSA水平增加，其中92%（23/25）的BFXM > 359（MESF约为34000）的患者发生AHR。通过单抗原珠测量的BFXM和总DSA在宽范围内相关性良好，表明任一者均可用于监测。我们的结论是，AHR与移植后高DSA水平的发展有关，旨在维持较低水平DSA的方案可能会降低AHR的发生率。
We examined the course of donor-specific alloantibody (DSA) levels early after transplant and their relationship with acute humoral rejection (AHR) in two groups of positive crossmatch (+XM) kidney transplant recipients: High DSA group-41 recipients with a baseline T- or B-cell flow crossmatch (TFXM, BFXM) channel shift >= 300 (molecules of equivalent soluble fluorochrome units (MESF) of approximately 19 300) who underwent pretransplant plasmapheresis (PP), and Low DSA group-29 recipients with a baseline channel shift < 300 who did not undergo PP. The incidence of AHR was 39% (16/41) in the High DSA group and 31% (9/29) in the Low DSA group. Overall, mean DSA levels decreased by day 4 posttransplant and remained low in patients who did not develop AHR. By day 10, DSA levels increased in patients developing AHR with 92% (23/25) of patients with a BFXM > 359 (MESF of approximately 34 000) developing AHR. The BFXM and the total DSA measured by single antigen beads correlated well across a wide spectrum suggesting that either could be used for monitoring. We conclude that AHR is associated with the development of High DSA levels posttransplant and protocols aimed at maintaining DSA at lower levels may decrease the incidence of AHR.