DQ molecules are the principal stimulators of de novo donor-specific antibodies in nonsensitized pediatric recipients receiving a first kidney transplant
DQ molecules are the principal stimulators of de novo donor-specific antibodies in nonsensitized pediatric recipients receiving a first kidney transplant
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DOI：
10.1111/tri.12316
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发表时间：
2014-07-01
影响因子：
3.1
通讯作者：
Nocera, Arcangelo
中科院分区：
文献类型：
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作者：
Tagliamacco, Augusto;Cioni, Michela;Nocera, Arcangelo
关于儿童肾移植后产生供体特异性抗体（DSA）的不同hla抗体（Ab）类别的数据很少。我们回顾性地评估了82例连续的非致敏儿童首次肾移植受者的新生HLA - Ab发生率和抗原特异性。在中位6年的随访中，29%的患者发生了新的DSA，而45%的患者发生了新的非DSA。DSA出现于移植后25个月，主要针对HLA-DQ抗原。考虑到每种HLA抗原，DQ型DSA的估计发生率（7.55 / 100人-年）远高于非DQ型DSA的发生率。HLA-DQ Ab在70%的病例中识别DQ链的决定因子，在25%的病例中识别链，在一个患者中识别两个链。非DSA比DSA更早达到峰值，并且在56%的病例中主要针对HLA- a和HLA- b相关交叉反应表位组（CREG）的HLA I类特异性。我们的研究结果表明，有必要评估肾脏分配中的HLA-DQ相容性，以尽量减少移植后新发生的DSA，已知DSA是抗体介导的排斥反应和移植物损失的原因。
Data on the different HLA-antibody (Ab) categories in pediatric kidney recipients developing de novo donor-specific Abs (DSA) after transplantation are scarce. We retrospectively evaluated 82 consecutive nonsensitized pediatric recipients of a first kidney graft for de novo HLA Ab occurrence and antigen specificity. At a median follow-up of 6 years, 29% of patients developed de novo DSA, while 45% had de novo non-DSA. DSA appeared at 25-month median time post-transplant and were mostly directed toward HLA-DQ antigens. Considering each HLA antigen, the estimated rate of DQ DSA (7.55 per 100 person-years) was much higher than the rates observed for non-DQ DSA. The HLA-DQ Ab recognized determinants of the DQ chain in 70% of cases, chain in 25% of cases, and both chains in one patient. Non-DSA peaked earlier than DSA, and were largely directed against HLA class I specificities that belonged to HLA-A- and HLA-B-related cross-reacting epitope groups (CREG) in 56% of cases. Our results indicate a need for evaluating HLA-DQ compatibilities in kidney allocation, in order to minimize post-transplant development of de novo DSA, known to be responsible for antibody-mediated rejection and graft loss.