Significance of low-level DSA detected by solid-phase assay in association with acute and chronic antibody-mediated rejection
Significance of low-level DSA detected by solid-phase assay in association with acute and chronic antibody-mediated rejection
复制标题
DOI：
10.1111/j.1432-2277.2012.01518.x
复制
发表时间：
2012-09-01
影响因子：
3.1
通讯作者：
Tanabe, Kazunari
中科院分区：
文献类型：
--
作者：
Hirai, Toshihito;Kohei, Naoki;Tanabe, Kazunari
我们试图澄清一个有争议的问题，即通过单抗原流珠测定 (SAFB) 检测低水平抗供体特异性 HLA 抗体 (HLA-DSA) 是否可能在减少急性和慢性抗体介导的排斥反应 (AMR) 方面发挥潜在作用。我们使用 Luminex 平台回顾性研究了 2001 年至 2004 年间 SAFB 移植的 ABO 相容活体肾移植受者的术前血清。 24 名患者仅通过 SAFB 检测到 HLA-DSA，尽管所有患者均显示 T 细胞和 B 细胞补体依赖性细胞毒性 (CDC) 交叉配型阴性。 HLA-DSA 患者尽管只是微弱致敏，但其急性和慢性 AMR 水平却出人意料地高（急性 AMR，33.3%；慢性 AMR，41.7%）。 2005年以后，我们常规实施SAFB，任何HLA-DSA阳性的患者都被认为是脱敏候选者。 52例发现HLA-DSA的患者在2001年至2004年间常用的治疗方案基础上，先行单剂利妥昔单抗（RIT）治疗，并进行三至四次双重滤过血浆置换（DFPP）治疗后接受肾移植。2005年以后，急慢性AMR的发生率显着下降（急性AMR，4.7%，P < 0.001； 慢性 AMR，4.7%，P < 0.001）。实施SAFB后5年移植物存活率也有所提高（83.398.1%，P = 0.032）。即使 DSA 水平较低的患者，RIT/DFPP 诱导方案也可以改善移植物存活率。
We sought to clarify the controversial issue of whether detecting low-level anti-donor-specific HLA antibody (HLA-DSA) by single-antigen flow-bead assay (SAFB) may have a potential role in reducing acute and chronic antibody-mediated rejection (AMR). We retrospectively studied the preoperative serum of ABO-compatible living kidney transplantation recipients transplanted between 2001 and 2004 by SAFB using a Luminex platform. HLA-DSA was detected only by SAFB in 24 patients, although all of them showed negative T-cell and B-cell complement-dependent cytotoxicity (CDC) crossmatches. The HLA-DSA patients went on to have surprisingly high levels of acute and chronic AMR despite being only weakly sensitized (acute AMR, 33.3%; chronic AMR, 41.7%). After 2005, we implemented SAFB routinely and any patient having a positive HLA-DSA was considered to be a desensitization candidate. The 52 patients found to have HLA-DSA underwent kidney transplantation after prior treatment with a single dose of rituximab (RIT) and three or four sessions of double-filtration plasmapheresis (DFPP) in addition to regimens commonly used between 2001 and 2004. After 2005, there was a significant reduction in the occurrence of acute and chronic AMR (acute AMR, 4.7%, P < 0.001; chronic AMR, 4.7%, P < 0.001). The 5-year graft survival rate also improved after implementing SAFB (83.398.1%, P = 0.032). The RIT/DFPP-induction protocol may improve graft survival even in patients with low-level DSA.