Anti-HLA donor-specific antibodies detected in positive B-cell crossmatches by Luminex® predict late graft loss
Anti-HLA donor-specific antibodies detected in positive B-cell crossmatches by Luminex® predict late graft loss
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DOI：
10.1111/j.1600-6143.2008.02387.x
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发表时间：
2008-11-01
影响因子：
8.8
通讯作者：
Russ, G. R.
中科院分区：
文献类型：
--
作者：
Eng, H. S.;Bennett, G.;Russ, G. R.
B 细胞交叉配血在肾移植中的意义存在争议。对 1987 年至 2005 年在单一中心进行移植且具有完整 T 细胞和 B 细胞交叉配记录的受者 (n = 471) 进行了研究。使用 Luminex (R) 对来自 83 名患者的血清进行了研究，该血清通过阳性 B 细胞交叉配型移植，同时在当前和/或峰值血清上进行阴性 T 细胞交叉配型 (T-B+)，以确定供体特异性抗体 (DSA) 的存在。将 T-B+ 患者的临床结果与 386 名 T-B- 患者进行比较。 T-B+ 预测血管排斥反应 (p = 0.01)，但不能预测细胞排斥反应 (p = 0.82) 或肾小球排斥反应 (p = 0.14)。 33% (n = 27) 的 T-B+ 患者中发现 IgG HLA DSA，并且与 6 个月时任何排斥反应 (p = 0.047)、血管排斥反应 (p = 0.01) 或肾小球排斥反应 (p < 0.001) 的较高风险相关。在 27 名 DSA 患者中，18/21 (86%) 是补体固定 IgG(1) 和/或 IgG(3) 亚类抗体。 DSA 导致移植后 5 年移植物丢失的风险显着升高（1.8 [1.0-3.3]，p = 0.045）。这项研究表明，只有三分之一的阳性 B 细胞交叉配型 (BXM) 是由 DSA 引起的，并且与晚期移植物丢失相关。因此，使用 BXM 来排除肾移植可能会对超过 60% 的 BXM 不表明存在 DSA 的患者不利。
The significance of B-cell crossmatching in kidney transplantation is controversial. Recipients (n = 471) transplanted in a single centre from 1987 to 2005 with complete T- and B-cell crossmatch records were studied. Sera from 83 patients transplanted across a positive B-cell crossmatch, with concomitant negative T-cell crossmatch (T-B+) on either current and/or peak sera were studied using Luminex (R) to determine presence of donor-specific antibodies (DSA). Clinical outcomes of T-B+ patients were compared with 386 T-B- patients. T-B+ predicted vascular (p = 0.01), but not cellular (p = 0.82) or glomerular (p = 0.14) rejection. IgG HLA DSA were found in 33% (n = 27) of the T-B+ patients and were associated with higher risk of any (p = 0.047), vascular (p = 0.01) or glomerular (p < 0.001) rejection at 6 months. Of 27 patients with DSA, 18/21 (86%) were the complement-fixing IgG(1) and/or IgG(3) subclass antibodies. DSA imposed a statistically significant higher risk of graft loss 5 years posttransplant (1.8 [1.0-3.3], p = 0.045). This study showed that only one-third of positive B-cell crossmatch (BXM) was caused by DSA and was associated with late graft loss. Thus, using BXM to preclude kidney transplantation may potentially disadvantage > 60% of patients in whom BXM is not indicative of the presence of DSA.