Preformed Donor-Specific HLA Antibodies in Living and Deceased Donor Transplantation: A Multicenter Study
Preformed Donor-Specific HLA Antibodies in Living and Deceased Donor Transplantation: A Multicenter Study
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DOI：
10.2215/cjn.13401118
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发表时间：
2019-07-05
影响因子：
9.8
通讯作者：
Lachmann, Nils
中科院分区：
文献类型：
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作者：
Ziemann, Malte;Altermann, Wolfgang;Lachmann, Nils
背景和目的预先形成的供者特异性HLA抗体（DSA）的预后价值，只能通过敏感的方法检测，对于肾移植仍然存在争议。设计，设置，参与者和测量2012年至2015年在18个德国移植中心进行的4233例连续肾移植的结果进行了评估。大多数中心采用逐步移植前抗体筛查与珠阵列测试和分化阳性样本的单一抗原测定。利用这些筛选结果，确定针对HLA-A、-B、-C、-DRB 1和-DQB 1的DSA。对临床结果和可能的协变量的数据进行了回顾性收集。结果移植前DSA与较低的总移植物存活率相关，活体捐赠的风险比为2.53（95%可信区间[95%CI]，1.49至4.29; P= 3000 MFI。结论预DSA与肾移植中移植物丢失的风险增加有关，活着的人比死去的人捐赠的多。即使是弱DSA
Background and objectivesThe prognostic value of preformed donor-specific HLA antibodies (DSA), which are only detectable by sensitive methods, remains controversial for kidney transplantation.Design, setting, participants, & measurementsThe outcome of 4233 consecutive kidney transplants performed between 2012 and 2015 in 18 German transplant centers was evaluated. Most centers used a stepwise pretransplant antibody screening with bead array tests and differentiation of positive samples by single antigen assays. Using these screening results, DSA against HLA-A, -B, -C, -DRB1 and -DQB1 were determined. Data on clinical outcome and possible covariates were collected retrospectively.ResultsPretransplant DSA were associated with lower overall graft survival, with a hazard ratio of 2.53 for living donation (95% confidence interval [95% CI], 1.49 to 4.29; P= 3000 MFI.ConclusionsPreformed DSA were associated with an increased risk for graft loss in kidney transplantation, which was greater in living than in deceased donation. Even weak DSA