Donor-specific HLA-DQ antibodies may contribute to poor graft outcome after renal transplantation
Donor-specific HLA-DQ antibodies may contribute to poor graft outcome after renal transplantation
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DOI：
10.1038/ki.2012.190
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发表时间：
2012-09-01
影响因子：
19.6
通讯作者：
Patel, Samir J.
中科院分区：
文献类型：
--
作者：
DeVos, Jennifer M.;Gaber, A. Osama;Patel, Samir J.
越来越多的证据表明，针对人类白细胞抗原 (HLA)-A、-B 和 -DR 基因座的供体特异性抗体对肾同种异体移植结果产生不利影响。关于从头 HLA-DQ 抗体的影响的数据有限。在 3 年的时间里，我们前瞻性地监测了 347 名没有移植前供者特异性抗体的肾移植受者的从头发育情况。经过 26 个月的随访，62 名患者产生了供者特异性抗体，其中 48 名患者单独携带 HLA-DQ 抗体（33 名患者），或与 HLA-A、-B 或 -DR 抗体联合使用（15 名患者）。只有 14 名患者产生了供者特异性 HLA-A、-B 或 -DR 抗体，但不存在 HLA-DQ 抗体。仅有 HLA-DQ 的患者中有 21% 发生急性排斥反应，与没有供体特异性抗体的患者的 11% 相比，这一比例微不足道。在最后一次随访中，仅产生 HLA-DQ 的患者的平均血清肌酐和蛋白尿患者的比例显着高于没有抗体的患者。与单独使用 HLA-DQ、单独使用非 DQ 抗体或不使用抗体 (92-94%) 相比，当 HLA-DQ 抗体与非 DQ 抗体联合使用时 (52%)，3 年移植物存活率明显较差。因此，我们的前瞻性监测研究发现，供者特异性 HLA-DQ 抗体是检测到的最常见类型，这些抗体可能会导致移植效果较差。持续监测对于确定产生 HLA-DQ 供体特异性抗体的患者的长期结果是必要的。
Increasing evidence suggests a detrimental effect of donor-specific antibodies directed against the human leukocyte antigen (HLA)-A, -B, and -DR loci on renal allograft outcomes. Limited data exist on the impact of de novo HLA-DQ antibodies. Over a 3-year period, we prospectively monitored 347 renal transplant recipients without pre-transplant donor-specific antibodies for their development de novo. After 26 months of follow-up, 62 patients developed donor-specific antibodies, of which 48 had a HLA-DQ antibody either alone (33 patients) or in combination with an HLA-A, -B, or -DR antibody (15 patients). Only 14 patients developed a donor-specific HLA-A, -B, or -DR antibody without a HLA-DQ antibody present. Acute rejection occurred in 21% of the HLA-DQ-only patients, insignificant when compared with 11% of patients without donor-specific antibodies. At the last follow-up, the mean serum creatinine and the fraction of patients with proteinuria were significantly higher in those that developed only HLA-DQ than those without antibodies. The 3-year graft survival was significantly worse when HLA-DQ antibodies were combined with non-DQ antibodies (52%) compared with HLA-DQ alone, non-DQ antibodies alone, or no antibodies (92-94%). Thus, our prospective monitoring study found that donor-specific HLA-DQ antibodies were the most common type detected and these antibodies may contribute to inferior graft outcomes. Ongoing surveillance is necessary to determine the long-term outcome of patients developing HLA-DQ donor-specific antibodies.