Efficacy of Induction Therapy with ATG and Intravenous Immunoglobulins in Patients with Low-Level Donor-Specific HLA-Antibodies
Efficacy of Induction Therapy with ATG and Intravenous Immunoglobulins in Patients with Low-Level Donor-Specific HLA-Antibodies
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DOI：
10.1111/j.1600-6143.2010.03093.x
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发表时间：
2010-05-01
影响因子：
8.8
通讯作者：
Schaub, S.
中科院分区：
文献类型：
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作者：
Baechler, K.;Amico, P.;Schaub, S.
低水平供者特异性的人类白细胞抗原抗体(HLA-DSA)(即可被单一抗原流动珠检测，但补体依赖的细胞毒性交叉配型检测为阴性)是同种异体移植早期排斥反应的危险因素。由多克隆抗T淋巴细胞球蛋白(ATG)和静脉注射免疫球蛋白(IVIG)组成的诱导方案对低水平HLA-DSA患者的短期疗效尚不清楚。在这项研究中，我们比较了67例未接受ATG/IVIG诱导的低水平HLA-DSA患者(历史对照)和37例接受ATG/IVIG诱导的患者。两组在再移植、HLA配型、HLA-DSA的数量和分类方面是相同的。ATG/IVIG组临床/亚临床抗体介导的排斥反应(AMR)的总体发生率低于历史对照组(38%比55%；p=0.03)。这是由于临床AMR发生率显著降低(11%vs.46%；p=0.0002)。ATG/IVIG组的临床T细胞介导的排斥反应(TCR)显著低于历史对照组(0%比50%；p<；0.0001)。在第一年内，由于AMR造成的移植物丢失在历史对照组中为7.5%，在ATG/IVIG组中为0%。我们的结论是，在低水平的HLA-DSA患者中，ATG/IVIG诱导显著降低了TCR和AMR的严重程度，但亚临床AMR的高发生率表明
Low-level donor-specific HLA-antibodies (HLA-DSA) (i.e. detectable by single-antigen flow beads, but negative by complement-dependent cytotoxicity cross-match) represent a risk factor for early allograft rejection. The short-term efficacy of an induction regimen consisting of polyclonal anti-T-lymphocyte globulin (ATG) and intravenous immunoglobulins (IvIg) in patients with low-level HLA-DSA is unknown. In this study, we compared 67 patients with low-level HLA-DSA not having received ATG/IvIg induction (historic control) with 37 patients, who received ATG/IvIg induction. The two groups were equal regarding retransplants, HLA-matches, number and class of HLA-DSA. The overall incidence of clinical/subclinical antibody-mediated rejection (AMR) was lower in the ATG/IvIg than in the historic control group (38% vs. 55%; p = 0.03). This was driven by a significantly lower rate of clinical AMR (11% vs. 46%; p = 0.0002). Clinical T-cell-mediated rejection (TCR) was significantly lower in the ATG/IvIg than in the historic control group (0% vs. 50%; p < 0.0001). Within the first year, allograft loss due to AMR occurred in 7.5% in the historic control and in 0% in the ATG/IvIg group. We conclude that in patients with low-level HLA-DSA, ATG/IvIg induction significantly reduces TCR and the severity of AMR, but the high rate of subclinical AMR suggests