HLA-DQ Mismatching and Kidney Transplant Outcomes
HLA-DQ Mismatching and Kidney Transplant Outcomes
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DOI：
10.2215/cjn.10860917
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发表时间：
2018-05-07
影响因子：
9.8
通讯作者：
Cardarelli, Francesca
中科院分区：
文献类型：
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作者：
Leeaphorn, Napat;Pena, Jeremy Ryan A.;Cardarelli, Francesca
背景和目的最近的证据表明，HLA- dq位点的HLA表位错配与抗dq供体特异性抗体的产生和不良移植结果有关。然而，广泛抗原HLA-DQ错配对移植物结果的临床意义尚未得到很好的研究。设计、设置、参与者和测量使用联合网络器官共享/器官获取和移植网络（UNOS/OPTN）数据，纳入2005年至2014年间进行原发性肾移植的患者。患者被分类为零HLA-DQ错配，或一个或两个HLA-DQ错配。主要结局是死亡后的移植存活和急性排斥反应的发生率。结果共纳入93782例患者。其中，22730例（24%）和71052例（76%）分别接受了零和一个或两个HLA-DQ不匹配的肾脏。在调整了包括HLA-ABDR在内的变量后，HLA-DQ错配与活体肾供体受者移植损失的高风险相关，调整后的危险比（HR）为1.18(95%置信区间[95% CI]， 1.07至1.30；P, 0.01)，但与已故肾供体受者无关（HR, 1.05; 95% CI， 0.98至1.12；P=0.18）（相互作用的P值，0.01）。当考虑冷缺血时间时，HLA-DQ错配与冷缺血时间为17小时的死亡肾供体受者移植损失的高风险相关（HR, 0.97; 95% CI， 0.88至1.06；P=0.49）（相互作用的pvalue， 0.01）。有一个或两个HLA-DQ错配肾脏的受者在1年时急性排斥反应发生率较高，死亡供者的校正比值比为1.13 (95% CI， 1.03至1.23；P, 0.01)，活体供者肾移植受者的校正比值比为1.14 （95% CI， 1.03至1.27；P=0.02）。特异性供体- dq错配似乎与急性排斥反应和移植物衰竭的风险有关，而其他供体- dq错配则与此无关。结论HLA-DQ错配与冷缺血时间下的活体肾移植和死亡供肾移植不依赖HLA-ABDR的移植物存活率降低有关
Background and objectives Recent evidence suggests that HLA epitope-mismatching at HLA-DQ loci is associated with the development of anti-DQ donor-specific antibodies and adverse graft outcomes. However, the clinical significance of broad antigen HLA-DQ mismatching for graft outcomes is not well examined.Design, setting, participants,& measurements Using the United Network Organ Sharing/the Organ Procurement and Transplantation Network(UNOS/OPTN) data, patients with primary kidney transplants performed between 2005 and 2014 were included. Patients were classified as having either zero HLA-DQ mismatches, or one or two HLA-DQ mismatches. Primary outcomes were death-censored graft survival and incidence of acute rejection.Results A total of 93,782 patients were included. Of these, 22,730 (24%) and 71,052 (76%) received zero and one or two HLA-DQ mismatched kidneys, respectively. After adjusting for variables including HLA-ABDR, HLA-DQ mismatching was associated with a higher risk of graft loss in living kidney donor recipients with an adjusted hazard ratio (HR) of1.18(95% confidence interval[95% CI], 1.07 to1.30; P, 0.01), butnot in deceased kidney donor recipients (HR, 1.05; 95% CI, 0.98 to 1.12; P=0.18) (P value for interaction,0.01). When taking cold ischemic time into account, HLA-DQ mismatching was associated with a higher risk of graft loss in deceased kidney donor recipients with cold ischemic time 17 hours (HR, 0.97; 95% CI, 0.88 to 1.06; P=0.49)(Pvalueforinteraction, 0.01). Recipients with one or two HLA-DQ mismatched kidneys had a higher incidence of acute rejection at 1 year, with adjusted odds ratios of 1.13 (95% CI, 1.03 to 1.23; P, 0.01) in deceased donor and 1.14 (95% CI, 1.03 to 1.27; P=0.02) in living donor kidney transplant recipients. Specific donor-DQ mismatches seemed to be associated with the risk of acute rejection and graft failure, whereas others did not.Conclusions HLA-DQ mismatching is associated with lower graft survival independent of HLA-ABDR in living donor kidney transplants and deceased donor kidney transplants with cold ischemia time