HLA-specific antibodies are associated with high-grade and persistent-recurrent lung allograft acute rejection
HLA-specific antibodies are associated with high-grade and persistent-recurrent lung allograft acute rejection
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DOI：
10.1016/j.healun.2003.08.030
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发表时间：
2004-10-01
影响因子：
8.9
通讯作者：
Zeevi, A
中科院分区：
文献类型：
--
作者：
Girnita, AL;McCurry, KR;Zeevi, A
背景：HLA特异性抗体在同种异体肺移植急性排斥反应中的作用尚未完全确定。急性排斥反应是最重要的危险因素的发展慢性肺移植dysfunction.Methods：我们分析了HLA抗体的模式，移植前和移植后的54例患者，并与我们的数据的存在和高级别和持续复发的急性排斥反应的频率，在第一个18术后个月。急性排斥反应的诊断是基于组织学国际心脏和肺移植学会（ISHLT）发表的criteria.Results：10 54例患者有一个阳性的酶联免疫测定（ELISA）移植后。在90%的ELISA阳性患者中，HLA抗体的存在与持续复发性急性排斥反应相关，而在ELISA阴性组中，这一比例为34%（P < 0.005）。ELISA阳性组中有28例高度急性排斥反应，而ELISA阴性组中有36例（p < 0.0001）。ELISA阳性患者需要更大强度的免疫抑制治疗。与ELISA阴性患者相比，ELISA检测到抗HLA抗体的患者发生高度急性排斥反应和持续复发性急性排斥反应的可能性至少高3倍，发生多次持续复发性急性排斥反应的可能性高7倍。基于ELISA的HLA抗体筛查是一种可靠的方法，可以识别肺移植受者的高风险，级和持续复发性急性排斥反应。虽然闭塞性细支气管炎在肺移植患者的演变中似乎是一个不可逆转的点，但早期发现急性排斥反应的危险因素可以间接降低闭塞性细支气管炎的发生率。这些肺移植患者可能受益于免疫抑制策略的改变。
Background: The impact of HLA-specific antibodies is not well established in the acute rejection of lung allografts. Acute rejection represents the most important risk factor for the development of chronic lung allograft dysfunction.Methods: We analyzed the pattern of HLA antibodies before and after transplantation in 54 patients, and correlated our data with the presence and frequency of high-grade and persistent-recurrent acute rejection, during the first 18 post-operative months. The diagnosis of acute rejection was based on histologic International Society for Heart and Lung Transplantation (ISHLT)-published criteria.Results: Ten of 54 patients had a positive enzyme-linked immunoassay (ELISA) post-transplantation. In 90% of ELISA-positive patients, the presence of HLA antibodies was associated with persistent-recurrent acute rejections, compared with 34% in the ELISA-negative group (P < 0.005). There were 28 high-grade acute rejection episodes in the ELISA-positive group, compared with 36 in the ELISA-negative group (p < 0.0001). The ELISA-positive patients required a greater intensity of immunosuppressive therapy. The patients with ELISA-detected anti-HLA antibodies were at least 3-fold more likely to develop high-grade acute rejection and persistent-recurrent acute rejection, and 7-fold more likely to develop multiple episodes of persistent-recurrent acute rejection, compared with ELISA-negative patients.Conclusions: ELISA-based screening for the development of HLA antibodies is a reliable method that can identify lung transplant recipients at increased risk for high-grade and persistent-recurrent acute rejection. Although bronchiolitis obliterans appears as a point of no return in the evolution of lung transplanted patients, early detection of risk factors for acute rejection could indirectly decrease the incidence of bronchiolitis obliterans. These lung-transplanted patients may benefit from an altered strategy of immunosuppression.