Human leukocyte antigen eplet mismatches and long-term clinical outcomes in pediatric renal transplantation: A pragmatic, registry-based study
Human leukocyte antigen eplet mismatches and long-term clinical outcomes in pediatric renal transplantation: A pragmatic, registry-based study
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DOI：
10.1111/petr.13705
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发表时间：
2020-04-22
影响因子：
1.3
通讯作者：
Kausman, Joshua
中科院分区：
文献类型：
--
作者：
Sypek, Matthew P.;Hiho, Steve;Kausman, Joshua
背景：基于HLA表位的配型为改善接受肾移植的儿童的免疫风险预测和管理提供了可能;方法我们对维多利亚的原发性肾移植的儿科受者进行了一项实用的、回顾性的、基于登记的研究，澳大利亚1990年至2014年之间，以确定HLA EpMM和临床结果，包括移植失败，再次移植和dnDSA形成之间的关联。中位随访期为15年，在此期间，108例（55%）初次移植失败，72例患者再次移植。HLA I类而非II类EpMM在单变量分析中是移植失败的显著预测因子，但在校正模型中不是。在单变量但未校正的分析中，EpMM与再次移植的可能性降低相关。在研究的局限性内，类特异性EpMM是dnDSA形成的强预测因子。当只考虑抗体验证EpMM的子集时，相关性更强。结论单变量分析中看到的儿童肾移植受者HLA EpMM和临床结局之间的关联在调整混杂因素后减弱。这些研究结果是不确定的，但表明，HLA EpMM可能提供一种工具，用于评估长期的风险，在这一人群中，同时强调需要进一步的临床研究。
Background HLA epitope-based matching offers the potential to improve immunological risk prediction and management in children receiving renal allografts; however, studies demonstrating the association between systems for defining epitope mismatches and clinical end-points are lacking in this population.Methods We conducted a pragmatic, retrospective, registry-based study of pediatric recipients of primary renal allografts in Victoria, Australia between 1990 and 2014 to determine the association between HLA EpMM and clinical outcomes including graft failure, re-transplantation and dnDSA formation.Results A total of 196 patients were included in the analysis with a median age of 11 years. Median follow-up period was 15 years during which time 108 (55%) primary grafts failed and 72 patients were re-transplanted. HLA class I but not class II EpMM was a significant predictor of graft failure on univariate analysis but not in adjusted models. EpMM was associated with reduced likelihood of re-transplantation in univariate but not adjusted analysis. Within the limitations of the study, class-specific EpMM was a strong predictor of dnDSA formation. Associations were stronger when considering only the subset of antibody-verified EpMM.Conclusion Associations between HLA EpMM and clinical outcomes in pediatric renal allograft recipients seen on univariate analysis were attenuated following adjustment for confounders. These findings are inconclusive but suggest that HLA EpMM may provide one tool for assessing long-term risk in this population while highlighting the need for further clinical studies.