Post-transplant anti-HLA class II antibodies as risk factor for late kidney allograft failure
Post-transplant anti-HLA class II antibodies as risk factor for late kidney allograft failure
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DOI：
10.1111/j.1600-6143.2006.01503.x
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发表时间：
2006-10-01
影响因子：
8.8
通讯作者：
Gerbase-DeLima, M.
中科院分区：
文献类型：
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作者：
Campos, E. F.;Tedesco-Silva, H.;Gerbase-DeLima, M.
本研究的目的是前瞻性分析移植后抗HLA I类和/或II类群体反应性抗体与慢性移植物肾病（CAN）引起的移植物衰竭之间的关系。我们研究了512例在一个中心进行的首次肾移植受者，移植物功能至少3年。从每名患者中采集一份血液样本用于抗体评价。采血后的中位移植后时间为4.4年，在有（n = 91）或无抗HLA抗体（n = 421）的患者之间没有差异。女性、妊娠和输血与抗HLA I类抗体的存在相关。移植物功能恶化与抗HLA II类抗体相关。多变量分析显示肌酐水平（RR = 7.5）、急性排斥反应（RR = 2.6）、受体男性（RR = 3.6）和抗HLA II类抗体（RR = 2.9）与CAN相关移植物丢失独立相关。总之，在肾功能下降之前，抗HLA II类抗体的存在赋予了移植物失功的风险，并增加了已经有移植物功能下降的患者的移植物衰竭的风险。因此，抗HLA II类抗体监测是一个有用的工具，长期肾受体的管理。
The purpose of this study was to prospectively analyze the relationship between the post-transplant anti-HLA class I and/or class II panel reactive antibodies and graft failure due to chronic allograft nephropathy (CAN). We studied 512 first kidney recipients transplanted at a single center, with a graft functioning for at least 3 years. A single blood sample was collected from each patient for antibody evaluation. The median posttransplant time after blood collection was 4.4 years and did not differ between patients with (n = 91) or without anti-HLA antibodies (n = 421). Female gender, pregnancies and blood transfusions were associated with the presence of anti-HLA class I antibodies. Graft function deterioration was associated with anti-HLA class II antibodies. Multivariate analysis showed independent association for creatinine levels (RR = 7.5), acute rejection (RR = 2.6), recipient male gender (RR = 3.6) and anti-HLA class II antibodies (RR = 2.9) and CAN-associated graft loss. In conclusion, the presence of anti-HLA class II antibodies conferred a risk for graft loss before a decline in renal function and increased the risk of graft failure in patients who already had a decline in graft function. Thus, anti-HLA class II antibody monitoring is a useful tool for the management of long-term kidney recipients.