Evolution and Clinical Pathologic Correlations of De Novo Donor-Specific HLA Antibody Post Kidney Transplant
Evolution and Clinical Pathologic Correlations of De Novo Donor-Specific HLA Antibody Post Kidney Transplant
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DOI：
10.1111/j.1600-6143.2012.04013.x
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发表时间：
2012-05-01
影响因子：
8.8
通讯作者：
Nickerson, P. W.
中科院分区：
文献类型：
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作者：
Wiebe, C.;Gibson, I. W.;Nickerson, P. W.
新发现的供者特异性抗体(DnDSA)患者的自然病史及其发展的危险因素尚未得到很好的确定。此外，临床和组织学与血清学数据的相关性有限。我们研究了连续315例肾移植患者，移植前未行DSA检查，平均随访6.2+/-2.9年。方案(n=215)和原因活检(n=163)进行分析。移植后dnDSA采用固相分析方法进行筛查。在315名患者中，共有47人(15%)在移植后平均4.6+/-3.0年发生dnDSA。DNDSA的独立预测因素为HLADRβ1 MM和Gt；0(OR5.66，p&t；0.006)和不依从性(OR8.75，p<；0.001)，且在DnDSA之前有较强的临床排斥倾向(OR1.57，每个排斥事件，p=0.061)。有dnDSA组的移植物10年存活率中位数低于无dnDSA组(57%vs.96%，p<；0.0001)。在没有移植物功能障碍的情况下，dnDSA患者可以发生与抗体介导的损伤相一致的病理变化，而且，不粘连和细胞排斥反应有助于dnDSA的发展和进展为移植物丢失。
The natural history for patients with de novo donor-specific antibodies (dnDSA) and the risk factors for its development have not been well defined. Furthermore, clinical and histologic correlation with serologic data is limited. We studied 315 consecutive renal transplants without pretransplant DSA, with a mean follow-up of 6.2 +/- 2.9 years. Protocol (n = 215) and for cause (n = 163) biopsies were analyzed. Solid phase assays were used to screen for dnDSA posttransplant. A total of 47 out of 315 (15%) patients developed dnDSA at a mean of 4.6 +/- 3.0 years posttransplant. Independent predictors of dnDSA were HLA-DR beta 1 MM > 0 (OR 5.66, p < 0.006); and nonadherence (OR 8.75, p < 0.001); with a strong trend toward clinical rejection episodes preceding dnDSA (OR 1.57 per rejection episode, p = 0.061). The median 10-year graft survival for those with dnDSA was lower than the No dnDSA group (57% vs. 96%, p < 0.0001). Pathology consistent with antibody-mediated injury can occur and progress in patients with dnDSA in the absence of graft dysfunction and furthermore, nonadherence and cellular rejection contribute to dnDSA development and progression to graft loss.