Clinical relevance of preformed HLA donor-specific antibodies in kidney transplantation
Clinical relevance of preformed HLA donor-specific antibodies in kidney transplantation
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DOI：
10.1111/j.1600-6143.2007.02072.x
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发表时间：
2008-02-01
影响因子：
8.8
通讯作者：
Glotz, D.
中科院分区：
文献类型：
--
作者：
Lefaucheur, C.;Suberbielle-Boissel, C.;Glotz, D.
本研究分析了预先DSA（通过HLA特异性ELISA检测）对移植物存活的影响，并评估了有和无移植物前脱敏的患者中抗体介导的排斥反应（AMR）的发生率。8年时，有DSA的患者（n = 43）的移植肾存活率明显低于无DSA的患者（n = 194）（p = 0.03）。DSA患者AMR的发生率是未行DSA患者的9倍（p < 0.001），其移植物存活率明显低于未行AMR的DSA患者和非DSA患者（p = 0.005）。在DSA患者中，在既往血清中检测到AMR的患病率在非脱敏患者中为32.3%，在脱敏患者中为41.7%。与DSA评分4的患者相比，DSA强阳性患者（评分6-8）的AMR风险显著升高（p < 0.001），并且与DSA+/CXM-患者相比，既往DSA+/CXM+患者的AMR风险显著升高（p = 0.01）。预先DSA的存在与肾移植中的移植物丢失密切相关，与AMR风险增加相关。我们的研究结果表明，在移植前DSA的检测和表征的重要性。这种风险的分层可用于确定肾脏分配，并为这些患者制定特定的策略。
This study analyzes the influence of preformed DSA, identified by HLA-specific ELISA assays, on graft survival and evaluates the incidence of antibody-mediated rejection (AMR) in patients with and without pregraft desensitization.Kidney graft survival at 8 years was significantly worse in patients with DSA (n = 43) than in those without DSA (n = 194)(p = 0.03). The incidence of AMR in patients with DSA is 9-fold higher than in patients without DSA (p < 0.001) and their graft survival is significantly worse than in DSA patients without AMR and in non-DSA patients (p = 0.005). The prevalence for AMR in patients with DSA detected on historic serum is 32.3% in nondesensitized patients and 41.7% in desensitized patients. The risk for AMR is significantly more elevated in patients with strongly positive DSA (score 6-8) compared to those with DSA score 4 (p < 0.001), and in patients with historic DSA+/CXM+ compared to those with DSA+/CXM- (p = 0.01).The presence of preformed DSA is strongly associated with graft loss in kidney transplants, related to an increased risk of AMR. Our findings demonstrate the importance of detection and characterization of DSA before transplantation. Stratification of this risk could be used to determine kidney allocation and to devise specific strategies for these patients.