HLA Loci and Recurrence of Focal Segmental Glomerulosclerosis in Pediatric Kidney Transplantation.
HLA Loci and Recurrence of Focal Segmental Glomerulosclerosis in Pediatric Kidney Transplantation.
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DOI：
10.1097/txd.0000000000001201
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发表时间：
2021-10
影响因子：
2.3
通讯作者：
Chambers ET
中科院分区：
文献类型：
--
作者：
Shaw BI;Ochoa A;Chan C;Nobuhara C;Gbadegesin R;Jackson AM;Chambers ET
肾移植后复发的局灶节段性肾小球硬化症（FSGS）占原发性FSGS患儿移植失败的大多数。虽然目前的研究集中在FSGS的病理生理学，一个共同的病因和疾病复发的机制仍然难以捉摸。我们对移植受者的科学登记进行了回顾性分析，以确定FSGS的特异性HLA复发的相关性。本研究包括19岁以下的肾移植受者，他们被诊断患有FSGS，在2000年1月1日之后移植，并且具有完整的HLA数据。我们对数据集中代表的所有HLA A、B、C、DR和DQ以及FSGS复发进行简单逻辑回归，然后使用Benjamini-Hochberg方法进行多重比较，确定与复发相关的因素。对于那些与复发相关的HLA，我们进一步确定了受体和供体HLA匹配对复发的影响。HLA DR 7、DR 53、DQ 2、DR 52和DQ 7与移植后疾病复发风险的增加或降低相关。我们确定了一个由HLA-DR 7、DR 53和DQ 2组成的风险单倍型，该单倍型与复发风险增加一致相关（比值比1.91; 95%置信区间，1.44-2.54，P < 0.001）。我们还发现供受者HLA-DQ 7一致性与复发风险降低相关（比值比0.42; 95%置信区间，0.37-0.53，P = 0.009）。HLA谱可用于儿童肾移植受者FSGS复发的危险分层，值得进一步研究。
Recurrent focal segmental glomerulosclerosis (FSGS) after kidney transplantation accounts for the majority of allograft failures in children with primary FSGS. Although current research focuses on FSGS pathophysiology, a common etiology and mechanisms of disease recurrence remain elusive. We performed a retrospective review of the Scientific Registry of Transplant Recipients to determine the association of specific HLA recurrence of FSGS. Kidney transplants recipients under the age of 19 who were diagnosed with FSGS, who were transplanted after January 1, 2000, and who had complete HLA data were included in the study. We performed simple logistic regression on all HLA A, B, C, DR, and DQ represented in the dataset and FSGS recurrence and then determined those associated with recurrence using the Benjamini–Hochberg method for multiple comparisons. For those HLAs that were associated with recurrence, we further determined the effect of matching recipient and donor HLA with recurrence. HLA DR7, DR53, DQ2, DR52, and DQ7 were associated with increased or decreased risk of recurrent disease after transplantation. We identified a risk haplotype consisting of HLA-DR7, DR53, and DQ2 that was consistently associated with an increased risk of recurrence (odds ratio 1.91; 95% confidence interval, 1.44-2.54, P < 0.001). We also found that donor/recipient concordance for HLA-DQ7 was associated with a decreased risk of recurrence (odds ratio 0.42; 95% confidence interval, 0.37-0.53, P = 0.009). HLA profiles may be used for risk stratification of recurrence of FSGS in pediatric kidney transplant recipients and deserves further study.