Abstract：
Islet transplantation is a unique paradigm in organ transplantation, since multiple donors are required to achieve complete insulin-independence. Preformed or de novo Donor Specific Antibodies (DSA) may target one or several donor islets, which adds complexity to the analysis of their impact. Adult patients with type 1 diabetes transplanted with pancreatic islets between 2005 and 2018 were included in a single-center observational study. Thirty-two recipients with available sera tested by solid-phase assays for anti-HLA antibodies during their whole follow-up were analyzed. Twenty-five recipients were islet-transplantation-alone recipients, and 7 islet-after-kidney recipients. Seven recipients presented with DSA at any time during follow-up (two with preformed DSA only, one with preformed and de novo DSA, 4 with de novo DSA only). Only islet-transplantation-alone recipients presented with de novo DSA. Three clinical trajectories were identified according to: 1/the presence of preformed DSA, 2/early de novo DSA or 3/late de novo DSA. Only late de novo DSA were associated with unfavorable outcomes, depicted by a decrease of the β-score. Islet transplantation with preformed DSA, even with high MFI values, is associated with favorable outcomes in our experience. On the contrary, de novo DSA, and especially late de novo DSA, may be associated with allograft loss.
摘要：
胰岛移植是器官移植中一个独特的范例,因为需要多个供体来实现完全的胰岛素独立性。预先形成或从头供体特异性抗体（DSA）可以靶向一个或几个供体胰岛，这增加了其影响分析的复杂性。2005年至2018年间移植胰岛的1型糖尿病成年患者被纳入单中心观察性研究。分析了在整个随访过程中通过固相测定抗HLA抗体检测血清的32名受体。25个接受者是胰岛移植单独接受者，和7个肾脏后胰岛受体。在随访期间的任何时候都有7名接受DSA的接受者（其中2名仅接受了预制DSA，一个有预制和从头DSA，4只带从头DSA)。只有单独的胰岛移植接受者才会出现从头DSA。根据以下方法确定了三个临床轨迹：1/存在预制DSA，2/早期从头DSA或3/晚期从头DSA。只有晚期从头DSA与不利结果相关，由β评分的降低描绘。预先形成的DSA胰岛移植，即使MFI值很高，与我们经验中的有利结果有关。相反,从头DSA，尤其是晚期从头DSA，可能与同种异体移植物丢失有关。
