Clinical relevance of pretransplant anti-HLA donor-specific antibodies: Does C1q-fixation matter?
Clinical relevance of pretransplant anti-HLA donor-specific antibodies: Does C1q-fixation matter?
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DOI：
10.1016/j.trim.2013.07.002
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发表时间：
2013-12-01
影响因子：
1.5
通讯作者：
Pascual, Julio
中科院分区：
文献类型：
--
作者：
Crespo, Marta;Torio, Alberto;Pascual, Julio
单抗原微球阵列（SAB）鉴定的抗HLA供者特异性抗体（DSA）因其灵敏度过高和缺乏移植后事件预测而受到质疑。人口和方法：我们回顾性评价了特定类型的预成形DSA（I类、II类或C1 q固定）及其对移植物存活的影响。包括阴性CDC交叉配型的肾移植（n = 355）。使用SAB测试抗HLA抗体以鉴定DSA及其固定C1 q的能力。结果：选择28例术前DSA（+）且MFI > 2000的患者进行C1 q固定评估。15例患者的DSA为C1 q+，13例为C1 q-，在人口统计学、急性排斥反应、移植物丢失或肾功能方面无显著差异。C1 q固定DSA患者的DSA最大MFI显著较高（p = 0.008）。DSA I级患者比II级患者遭受更多的抗体介导的排斥反应（AMR），移植物存活率更差。DSA I修复C1 q的能力与排斥反应、移植物功能或移植物丢失无关。结论：用DSA检测移植前血清中的C1 q不能预测急性抗体介导的排斥反应或早期移植物丢失，但与DSA II级相比，DSA I级的存在确实如此。尽管在体外非固定补体，移植前C1 q阴性DSA I可以介导排斥反应和移植物丢失。(C)2013爱思唯尔有限公司版权所有。
Anti-HLA donor-specific antibodies (DSA) identified by single antigen bead array (SAB) are questioned for their excess in sensitivity and lack of event prediction after transplantation. Population and methods: We retrospectively evaluated specific types of preformed-DSA (class I, class II or C1q-fixing) and their impact on graft survival. Kidney transplantations performed across negative CDC-crossmatch were included (n = 355). Anti-HLA antibodies were tested using SAB to identify DSA and their capacity to fix C1q. Results: Twenty-eight patients with pretransplant DSA(+) with MFI > 2000 were selected to assess C1q fixation. DSA were C1q + in 15 patients and C1q- in 13, without significant differences in demographics, acute rejection, graft loss or renal function. The maximum MFI of DSA in patients with C1q-fixing DSA was significantly higher (p = 0.008). Patients with DSA class-I suffered more antibody-mediated rejection (AMR) and had worse graft survival than class-II. The capacity of DSA I to fix C1q did not correlate with rejection, graft function or graft loss. Conclusions: C1q testing in pretransplant sera with DSA was unable to predict acute antibody-mediated rejection or early graft loss, but the presence of DSA class I compared to DSA only class II did. Despite non-fixing complement in vitro, pretransplant C1q-negative DSA I can mediate rejection and graft loss. (C) 2013 Elsevier B.V. All rights reserved.