De novo DQ donor-specific antibodies are associated with worse outcomes compared to non-DQ de novo donor-specific antibodies following heart transplantation
De novo DQ donor-specific antibodies are associated with worse outcomes compared to non-DQ de novo donor-specific antibodies following heart transplantation
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DOI：
10.1111/ctr.12924
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发表时间：
2017-04-01
影响因子：
2.1
通讯作者：
Gupta, Divya
中科院分区：
文献类型：
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作者：
Cole, Robert Townsend;Gandhi, Jonathan;Gupta, Divya
背景心脏移植（HTx）后，由于供体特异性抗体（denovo donor-specific antibodies，dnDSA）引起的抗体介导的排斥反应（antibody-mediated rejection，AMR）会导致不良后果。目前尚不清楚针对特定HLA抗原的dnDSA在不良结局中发挥的作用。本研究比较了那些发展非DQ dnDSA和那些免费从dnDSA.MethodsThe本研究是一个单中心，回顾性分析122个连续的HTx收件人的患者的结果，发展dnDSA DQ抗原。的主要结果是死亡或移植dysfunctions.ResultsAfter 3.3年的随访，31例（28%）患者发展dnDSA的复合。平均至dnDSA时间为539天。在31例患者中，19例发生DQ抗体，12例发生非DQ抗体。与非DQ dnDSA相比，MFI值较高（P=.001）的DQ抗体更可能持续存在（P=.001），并且在HTx后出现较晚（654 vs 359天，P=.035）。在多变量分析中，DQ dnDSA与主要终点风险增加相关（HR 6.15，95%CI 2.57-14.75，P= 0.001），而非DQ dnDSA未观察到风险增加（P= 0.749）。
BackgroundAntibody-mediated rejection (AMR) resulting from de novo donor-specific antibodies (dnDSA) leads to adverse outcomes following heart transplantation (HTx). It remains unclear what role dnDSA to specific HLA antigens play in adverse outcomes. This study compares outcomes in patients developing dnDSA to DQ antigens with those developing non-DQ dnDSA and those free from dnDSA.MethodsThe present study was a single-center, retrospective analysis of 122 consecutive HTx recipients. The primary outcome was a composite of death or graft dysfunction.ResultsAfter 3.3years of follow-up, 31 (28%) patients developed dnDSA. Mean time to dnDSA was 539days. Of 31 patients, 19 developed DQ antibodies and 12 developed non-DQ antibodies. Compared to non-DQ dnDSA, DQ antibodies presented with higher MFI values (P=.001) were more likely persistent (P=.001) and appeared later post-HTx (654 vs 359days, P=.035). In a multivariable analysis, DQ dnDSA was associated with increased risk of the primary endpoint (HR 6.15, 95% CI 2.57-14.75, P=.001), whereas no increased risk was seen with non-DQ dnDSA (P=.749).ConclusionsdnDSA to DQ antigens following HTx are associated with increased risk of death and graft dysfunction.