Association of HLA Typing and Alloimmunity With Posttransplantation Membranous Nephropathy: A Multicenter Case Series
Association of HLA Typing and Alloimmunity With Posttransplantation Membranous Nephropathy: A Multicenter Case Series
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DOI：
10.1053/j.ajkd.2020.01.009
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发表时间：
2020-09-01
影响因子：
13.2
通讯作者：
D'Agati, Vivette D.
中科院分区：
文献类型：
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作者：
Batal, Ibrahim;Vasilescu, Elena-Rodica;D'Agati, Vivette D.
理由与目的：移植后膜性肾病（MN）是肾移植中一种罕见的并发症，可分为复发性或新生性。移植后MN的临床、病理和免疫遗传学特征以及新生和复发MN之间的差异尚不清楚。研究设计：多中心病例系列。环境和参与者：我们纳入了来自北美和欧洲5个医疗中心的肾移植后MN患者77例（27例新发，50例复发）。原生肾MN患者接受同种异体肾移植，但未发生复发性MN，作为非复发对照（n = 43）。为了提高对移植后MN的理解，我们将新生MN与复发MN进行了比较，然后将复发MN与非复发对照进行了对比。结果：与复发性MN相比，新发MN不太可能被归类为原发性MN (OR, 0.04; P < 0.001)，并且有更多的并发抗体介导的排斥反应（OR, 12.0; P < 0.001）和较差的同种异体移植存活（同种异体移植失败的HR， 3.2; P = 0.007）。HLA-DQ2和HLA-DR17抗原在复发性MN患者中比新发MN患者更常见；然而，这些受体抗原在复发性MN中的频率与非复发性MN对照组相似。在93例MN原发肾衰竭的肾移植受者中，较大的受者年龄（HR /年岁，1.03;P = 0.02）、受体HLA-A3抗原（HR, 2.5; P = 0.003）、无类固醇免疫抑制方案（HR, 2.84; P < 0.001）和活体相关同种异体移植（HR, 1.94; P = 0.03）是MN复发的预测因素。局限性：回顾性病例系列，由于疾病罕见，样本量有限，数据收集和活检的非标准化性质。结论：新生和复发性MN可能代表不同的疾病。新生MN与体液异体免疫和保护性结局有关。MN复发的潜在易感因素包括老龄受体、HLA-A3抗原受体、无类固醇免疫抑制方案和活体供体肾。
Rationale & Objectives: Posttransplantation membranous nephropathy (MN) represents a rare complication of kidney transplantation that can be classified as recurrent or de novo. The clinical, pathologic, and immunogenetic characteristics of posttransplantation MN and the differences between de novo and recurrent MN are not well understood.Study Design: Multicenter case series.Setting & Participants: We included 77 patients from 5 North American and European medical centers with post-kidney transplantation MN (27 de novo and 50 recurrent). Patients with MN in the native kidney who received kidney allografts but did not develop recurrent MN were used as nonrecurrent controls (n = 43). To improve understanding of posttransplantation MN, we compared de novo MN with recurrent MN and then contrasted recurrentMN with nonrecurrent controls.Findings: Compared with recurrent MN, de novo MN was less likely to be classified as primary MN (OR, 0.04; P < 0.001) and had more concurrent antibody-mediated rejection (OR, 12.0; P < 0.001) and inferior allograft survival (HR for allograft failure, 3.2; P = 0.007). HLA-DQ2 and HLA-DR17 antigens were more common in recipients with recurrent MN compared with those with de novo MN; however, the frequency of these recipient antigens in recurrent MN was similar to that in nonrecurrent MN controls. Among the 93 kidney transplant recipients with native kidney failure attributed to MN, older recipient age (HR per each year older, 1.03; P = 0.02), recipient HLA-A3 antigen (HR, 2.5; P = 0.003), steroid-free immunosuppressive regimens (HR, 2.84; P < 0.001), and living related allograft (HR, 1.94; P = 0.03) were predictors of MN recurrence.Limitations: Retrospective case series, limited sample size due to rarity of the disease, nonstandardized nature of data collection and biopsies.Conclusions: De novo and recurrent MN likely represent separate diseases. De novo MN is associated with humoral alloimmunity and guarded outcome. Potential predisposing factors for recurrent MN include recipients who are older, recipient HLA-A3 antigen, steroid-free immunosuppressive regimen, and living related donor kidney.