Preexisting Donor-Specific HLA Antibodies Predict Outcome in Kidney Transplantation
Preexisting Donor-Specific HLA Antibodies Predict Outcome in Kidney Transplantation
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DOI：
10.1681/asn.2009101065
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发表时间：
2010-08-01
影响因子：
13.6
通讯作者：
Suberbielle-Boissel, Caroline
中科院分区：
文献类型：
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作者：
Lefaucheur, Carmen;Loupy, Alexandre;Suberbielle-Boissel, Caroline
目前尚不清楚移植时预先存在的人类白细胞抗原抗体的临床重要性。我们对402例连续的已故供者肾移植受者进行了一项观察性研究，分析了先前存在的供者特异性的人类白细胞抗原抗体(HLA-DSA)与急性抗体介导的排斥反应(AMR)的发生率以及患者和移植物的存活率之间的关系。我们用Luminex单抗原法检测峰值反应血清和当前血清中的人类白细胞抗原-DSA。所有患者在移植当天的淋巴细胞毒性交叉配型试验均为阴性。我们发现，与未致敏的致敏患者(93%)和未致敏的患者(84%)相比，既往存在的HLA-DSA患者的8年移植物存活率(61%)明显更差(61%)。峰值平均荧光强度(MFI)预测急性早幼粒细胞白血病的疗效优于现有的HLADSA平均荧光强度(P=0.028)。随着峰值血清上检测到的排名最高的HLA-DSA的MFI增加，移植物存活率下降，AMR的相对风险增加：MFI&>6000患者发生AMR的风险是MFI患者的100倍
The clinical importance of preexisting HLA antibodies at the time of transplantation, identified by contemporary techniques, is not well understood We conducted an observational study analyzing the association between preexisting donor-specific HLA antibodies (HLA-DSA) and incidence of acute antibody-mediated rejection (AMR) and survival of patients and grafts among 402 consecutive deceased-donor kidney transplant recipients. We detected HLA-DSA using Luminex single-antigen assays on the peak reactive and current sera. All patients had a negative lymphocytotoxic cross-match test on the day of transplantation. We found that 8-year graft survival was significantly worse (61%) among patients with preexisting HLA-DSA compared with both sensitized patients without HLA-DSA (93%) and nonsensitized patients (84%). Peak HLA-DSA Luminex mean fluorescence intensity (MFI) predicted AMR better than current HLA-DSA MFI (P = 0.028). As MFI of the highest ranked HLA-DSA detected on peak serum increased, graft survival decreased and the relative risk for AMR increased: Patients with MFI >6000 had >100-fold higher risk for AMR than patients with MFI