A paired kidney analysis on the impact of pre-transplant anti-HLA antibodies on graft survival

被引：14

作者：

Michielsen, Laura A. ^{[1
]}

Wisse, Bram W. ^{[2
]}

Kamburova, Elena G. ^{[2
]}

Verhaar, Marianne C. ^{[1
]}

Joosten, Irma ^{[3
]}

Allebes, Wil A. ^{[3
]}

van der Meer, Arnold ^{[3
]}

Hilbrands, Luuk B. ^{[4
]}

Baas, Marije C. ^{[4
]}

Spierings, Eric ^{[2
]}

Hack, Cornelis E. ^{[2
]}

van Reekum, Franka E. ^{[1
]}

Bots, Michiel L. ^{[5
]}

Drop, Adriaan C. A. D. ^{[2
]}

Plaisier, Loes ^{[2
]}

Seelen, Marc A. J. ^{[6
]}

Sanders, Jan-Stephan F. ^{[6
]}

Hepkema, Bouke G. ^{[7
]}

Lambeck, Annechien J. ^{[7
]}

Bungener, Laura B. ^{[7
]}

Roozendaal, Caroline ^{[7
]}

Tilanus, Marcel G. J. ^{[8
]}

Voorter, Christien E. ^{[8
]}

Wieten, Lotte ^{[8
]}

van Duijnhoven, Elizabeth M. ^{[9
]}

Gelens, Marielle ^{[9
]}

Christiaans, Maarten H. L. ^{[9
]}

van Ittersum, Frans J. ^{[10
]}

Nurmohamed, Shaikh A. ^{[10
]}

Lardy, Neubury M. ^{[11
]}

Swelsen, Wendy ^{[11
]}

van der Pant, Karlijn A. ^{[12
]}

van der Weerd, Neelke C. ^{[12
]}

ten Berge, Ineke J. M. ^{[12
]}

Bemelman, Frederike J. ^{[12
]}

Hoitsma, Andries ^{[13
]}

van der Boog, Paul J. M. ^{[14
]}

de Fijter, Johan W. ^{[14
]}

Betjes, Michiel G. H. ^{[15
]}

Heidt, Sebastiaan ^{[16
]}

Roelen, Dave L. ^{[16
]}

Claas, Frans H. ^{[16
]}

Otten, Henderikus G. ^{[2
]}

van Zuilen, Arjan D. ^{[1
]}

机构：

[1] Univ Utrecht, Univ Med Ctr Utrecht, Dept Nephrol & Hypertens, Utrecht, Netherlands

[2] Univ Utrecht, Univ Med Ctr Utrecht, Lab Translat Immunol, Utrecht, Netherlands

[3] Radboud Univ Nijmegen, Lab Med Immunol, Lab Med, Med Ctr, Nijmegen, Netherlands

[4] Radboud Univ Nijmegen, Radboud Inst Hlth Sci, Dept Nephrol, Med Ctr, Nijmegen, Netherlands

[5] Univ Utrecht, Univ Med Ctr Utrecht, Julius Ctr Hlth Sci & Primary Care, Utrecht, Netherlands

[6] Univ Groningen, Univ Med Ctr Groningen, Dept Nephrol, Groningen, Netherlands

[7] Univ Groningen, Univ Med Ctr Groningen, Dept Lab Med, Groningen, Netherlands

[8] Maastricht Univ, Dept Transplantat Immunol, Tissue Typing Lab, Med Ctr, Maastricht, Netherlands

[9] Maastricht Univ, Med Ctr, Div Nephrol, Dept Internal Med, Maastricht, Netherlands

[10] Vrije Univ Amsterdam, Amsterdam Univ, Med Ctr, Dept Nephrol, Amsterdam, Netherlands

[11] Sanquin, Dept Immunogenet, Amsterdam, Netherlands

[12] Acad Med Ctr, Amsterdam UMC, Renal Transplant Unit, Dept Internal Med, Amsterdam, Netherlands

[13] Dutch Transplant Fdn NTS, Dutch Organ Transplant Registry NOTR, Leiden, Netherlands

[14] Leiden Univ, Med Ctr, Dept Nephrol, Leiden, Netherlands

[15] Dept Nephrol, Rotterdam, Netherlands

[16] Leiden Univ, Med Ctr, Dept Immunohematol & Blood Transfus, Leiden, Netherlands

来源：

NEPHROLOGY DIALYSIS TRANSPLANTATION | 2019年 / 34卷 / 06期

关键词：

acute rejection; graft survival; HLA antibodies; immunology; kidney transplantation; DONOR-SPECIFIC ANTIBODIES; HUMAN-LEUKOCYTE ANTIGEN; DP-SPECIFIC ANTIBODIES; MEDIATED REJECTION; CLINICAL-RELEVANCE; RISK-FACTOR; BEAD ASSAY; LOSS EVEN; RECIPIENTS; INDUCTION;

D O I：

10.1093/ndt/gfy316

中图分类号：

R3 [基础医学]; R4 [临床医学];

学科分类号：

1001 ; 1002 ; 100602 ;

摘要：

Background Pre-transplant donor-specific anti-human leucocyte antigen (HLA) antibodies (DSAs) are associated with impaired kidney graft survival while the clinical relevance of non-donor-specific anti-HLA antibodies (nDSAs) is more controversial. The aim of the present paired kidney graft study was to compare the clinical relevance of DSAs and nDSAs. Methods To eliminate donor and era-dependent factors, a post hoc paired kidney graft analysis was performed as part of a Dutch multicentre study evaluating all transplantations between 1995 and 2005 with available pre-transplant serum samples. Anti-HLA antibodies were detected with a Luminex single-antigen bead assay. Results Among 3237 deceased donor transplantations, we identified 115 recipient pairs receiving a kidney from the same donor with one recipient being DSA positive and the other without anti-HLA antibodies. Patients with pre-transplant DSAs had a significantly lower 10-year death-censored graft survival (55% versus 82%, P=0.0001). We identified 192 pairs with one recipient as nDSA positive (against Class I and/or II) and the other without anti-HLA antibodies. For the patients with nDSAs against either Class I or II, graft survival did not significantly differ compared with patients without anti-HLA antibodies (74% versus 77%, P=0.79). Only in patients with both nDSAs Class I and II was there a trend towards a lower graft survival (58%, P=0.06). Lastly, in a small group of 42 recipient pairs, 10-year graft survival in recipients with DSAs was 49% compared with 68% in recipients with nDSAs (P=0.11). Conclusion This paired kidney analysis confirms that the presence of pre-transplant DSAs in deceased donor transplantations is a risk marker for graft loss, whereas nDSAs in general are not associated with a lower graft survival. Subgroup analysis indicated that only in broadly sensitized patients with nDSAs against Class I and II, nDSAs may be a risk marker for graft loss in the long term.

引用

页码：1056 / 1063

页数：8

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