Blood levels of donor-specific human leukocyte antigen antibodies after renal transplantation: Resolution of rejection in the presence of circulating donor-specific antibody
Blood levels of donor-specific human leukocyte antigen antibodies after renal transplantation: Resolution of rejection in the presence of circulating donor-specific antibody
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DOI：
10.1097/01.tp.0000284729.39137.6e
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发表时间：
2007-10-15
期刊：
影响因子：
6.2
通讯作者：
Briggs, David
中科院分区：
文献类型：
--
作者：
Higgins, Rob;Hathaway, Mark;Briggs, David
背景。抗体调节是abo血型不相容移植成功的重要机制，但其在人类白细胞抗原（HLA）抗体不相容移植中的重要性尚不清楚，因为用于日常测量供体特异性HLA抗体（dsa）的敏感技术直到最近才被开发出来。方法。我们报告了24例HLA抗体不相容肾移植患者（21例活体供体，3例死亡），其中21例移植前血浆置换。8例移植前血浆置换补体依赖性细胞毒性（CDC）交叉配型（XM）阳性，9例流式细胞术（FC） XM阳性，7例仅通过微珠分析检测DSA。移植后，用微珠法密切监测DSA水平。结果。在移植后中位数6.5天，8例cdc阳性病例中有5例（62.5%）出现排斥反应，9例fc阳性病例中有3例（33%）出现排斥反应，7例仅使用微珠的病例中有2例（29%）出现排斥反应。在移植后15天中位数出现分辨率，10例DSA微珠水平中位数荧光强度（MFI）为> 2000 U的有8例，10例微珠MFI为> 4000 U的有6例，10例微珠MFI在分辨率时大于发病时的有8例。DSA并不总是引起临床排斥反应。在5例移植后DSA在微珠检测中峰值为MFI - 2000 U的患者中，没有发生排斥反应。结论。这些数据表明，移植成功的主要方法是在循环DSA存在的情况下移植的功能，它们也确定了这种情况发生的时间。
Background. Accommodation to antibody is an important mechanism in successful ABO-incompatible transplantation, but its importance in human leukocyte antigen (HLA) antibody-incompatible transplantation is less clear, as sensitive techniques facilitating daily measurement of donor-specific HLA antibodies (DSAs) have only recently been developed. Methods. We report 24 patients who had HLA antibody-incompatible kidney transplantation (21 living donors, 3 deceased), 21 of whom had pretransplant plasmapheresis. Eight had positive complement-dependent cytotoxic (CDC) crossmatch (XM) pretransplant plasmapheresis, nine had positive flow cytometric (FC) XM, and seven had DSA detectable by microbead analysis only. After transplant, DSA levels were monitored closely with microbead assays. Results. Rejection occurred in five of eight (62.5%) CDC-positive cases, in three of nine (33%) FC-positive cases, and in two of seven (29%) of microbead-only cases at a median of 6.5 days after transplantation. Resolution occurred at a median of 15 days after transplantation, in 8 of 10 cases when the microbead level of DSA had median fluorescence intensity (MFI) > 2000 U, in 6 of 10 when the microbead MFI > 4000 U. In 8 of 10 cases, the microbead MFI at the time of resolution was greater than at the onset. DSA did not always cause clinical rejection. In five cases with a posttransplant DSA peaking at MFI > 2000 U on microbead assay, rejection did not occur. Conclusion. These data suggest that the dominant method of successful transplantation was function of the transplant in the presence of circulating DSA, and they also define the period during which this occurred.