Comparison of Physical Crossmatch and Virtual Crossmatch to Identify Preexisting Donor-Specific Human Leukocyte Antigen (HLA) Antibodies and Outcome Following Kidney Transplantation
Comparison of Physical Crossmatch and Virtual Crossmatch to Identify Preexisting Donor-Specific Human Leukocyte Antigen (HLA) Antibodies and Outcome Following Kidney Transplantation
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比较物理交叉配型和虚拟交叉配型以识别预先存在的供体特异性人类白细胞抗原 (HLA) 抗体和肾移植后的结果
DOI：
10.12659/msm.914902
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发表时间：
2019
影响因子：
3.1
通讯作者：
Ming Yingzi
中科院分区：
文献类型：
--
作者：
Peng Bo;Zhuang Quan;Yu Meng;Li Junhui;Liu Yun;Zhu Lijun;Ming Yingzi
背景：在等待肾移植的患者中，应用物理交叉匹配(PXM)和虚拟交叉匹配(VXM)来鉴定预先存在的供者特异性人类白细胞抗原(HLA)抗体。最近，高分辨率表位分析已经成为VXM的一种新策略。一项回顾性临床研究比较了PXM和VXM在肾移植前和移植后的受者结局。材料/方法2017年8月至2018年3月，239例患者接受了交叉配型，94例患者接受了供肾。补体依赖细胞毒(CDC)PXM试验和VXM使用血清学和表位分析鉴定了供体特异性抗体(DSA)。比较交叉配型结果和3个月后的临床结果。结果VXM检出血清学DSA 74例(31.0%)，确证表位DSA 39例(16.3%)，总表位DSA 49例(20.5%)。CDC法检测PXM阳性11例(4.6%)。94例肾移植受者中，21例sDSA阳性，PXM阴性，1例移植肾功能延迟，无超急性排斥反应或急性排斥反应。在73例sDSA阴性的受者中，8例发生了急性排斥反应(P=0.253)，19例发生了排斥反应(P=0.037)。术后3个月移植肾存活率差异无统计学意义。结论与血清学分析相比，高分辨表位分析可发现较少的DSA病例。由于有和没有sDSA的患者在PXM阴性的情况下有相似的短期结果，由VXM确定的先前存在的sDSA的存在不应成为肾移植的绝对禁忌症。
Background Physical crossmatch (PXM) and virtual crossmatch (VXM) are applied to identify preexisting donor-specific human leukocyte antigen (HLA) antibodies in patients awaiting kidney transplantation. Recently, high-resolution epitope analysis has emerged as a novel strategy for VXM. A retrospective clinical study compared PXM with VXM before kidney transplantation and recipient outcome following transplantation. Material/Methods Between August 2017 and March 2018, 239 patients underwent crossmatching and 94 patients received a donor kidney. A complement-dependent cytotoxicity (CDC) PXM assay and VXM using serological and epitope analysis identified donor-specific antibodies (DSA). Crossmatch results and clinical outcome at 3 months were compared. Results VXM identified serological DSA (sDSA), verified epitope DSA, and total epitope DSA in 74 (31.0%), 39 (16.3%), and 49 (20.5%) cases, respectively. Eleven cases (4.6%) had a positive PXM detected by the CDC assay. Of 94 kidney transplant recipients, 21 had preexisting sDSA but were negative in PXM; there was 1 case of delayed graft function (DGF) and no cases of hyperacute rejection or acute rejection. Of the rest of the 73 recipients who were negative for sDSA, 8 had acute rejection (P=0.253) and 19 had DGF (P=0.037). No significant differences were found in graft survival at 3 months. Conclusions High-resolution epitope analysis identified fewer cases with DSA compared with serological analysis. Because patients with and without sDSA had a similar short-term outcome in the setting of a negative PXM, the presence of preexisting sDSA, determined by VXM, should not be an absolute contraindication for kidney transplantation.