Clinical Significance of Pretransplant Donor-Specific Antibodies in the Setting of Negative Cell-Based Flow Cytometry Crossmatching in Kidney Transplant Recipients
Clinical Significance of Pretransplant Donor-Specific Antibodies in the Setting of Negative Cell-Based Flow Cytometry Crossmatching in Kidney Transplant Recipients
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DOI：
10.1111/ajt.13848
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发表时间：
2016-12-01
影响因子：
8.8
通讯作者：
Cooper, J. E.
中科院分区：
文献类型：
--
作者：
Adebiyi, O. O.;Gralla, J.;Cooper, J. E.
肾移植前通过单抗原珠（SAB）分析检测到的供体特异性HLA抗原抗体（供体特异性抗体[DSA]）与较差的移植结局相关。然而，移植前DSA的研究，特别是在没有脱敏治疗的情况下，阴性流式细胞术交叉配型（FCXM）的研究是有限的。对2007年9月至2012年8月期间移植前FCXM阴性的660例肾和肾-胰腺受体进行了分析，未接受脱敏治疗，中位随访时间为4.2年。所有患者在移植前均接受了基于细胞的FCXM和SAB对当前和历史血清的分析。162例患者（24.5%）在移植前进行了DSA检查。DSA阳性患者与DSA阴性患者的1年急性排斥反应发生率相似（分别为15.4%与11.4%; p = 0.18），多变量分析中DSA平均荧光强度（MFI）大于或等于3000的患者的1年急性排斥反应发生率较高（p = 0.046）。DSA（+）组与DSA（-）组相比，3年和4年时估计的肾小球滤过率（eGFR）较低（3年时p = 0.050），对5年死亡删失移植物存活率无影响（分别为89.0% vs. 90.6%; p = 0.53）。DSA检测的时间（当前或历史）并没有改变这些结果。总之，在FCXM阴性的情况下，移植前DSA在中期内具有最小的免疫风险，不需要脱敏治疗，也不应成为肾移植的障碍。
Antibodies to donor-specific HLA antigens (donor-specific antibodies [DSA]) detected by single-antigen bead (SAB) analysis prior to kidney transplant have been associated with inferior graft outcomes. However, studies of pretransplant DSA, specifically in the setting of a negative flow cytometry crossmatch (FCXM) without desensitization therapy, are limited. Six hundred and sixty kidney and kidney-pancreas recipients with a negative pretransplant FCXM from September 2007 to August 2012 without desensitization therapy were analyzed with a median follow-up of 4.2 years. All patients underwent cell-based FCXM and SAB analysis on current and historic sera prior to transplantation. One hundred and sixty-two patients (24.5%) had DSA detected prior to transplant. One-year acute rejection rates were similar in DSA-positive versus DSA-negative patients (15.4% vs. 11.4%, respectively; p = 0.18) and were higher in those with DSA mean fluorescence intensity (MFI) greater than or equal to 3000 in multivariable analysis (p = 0.046). The estimated glomerular filtration rate (eGFR) at 3 and 4 years was lower in the DSA(+) versus the DSA(-) group (p = 0.050 at 3 years) without an impact on 5-year death-censored graft survival (89.0% vs. 90.6%, respectively; p = 0.53). Timing (current or historic) of DSA detection did not alter these findings. In conclusion, pretransplant DSA in the setting of a negative FCXM confers minimal immunologic risk in the intermediate term, does not necessitate desensitization therapy and should not represent a barrier to renal transplant.