PDF(Pubmed)
Abstract：
Living donor (LD) kidney transplantation in the setting of ABO blood group incompatibility (ABOi) has been previously reported to be associated with increased risk for antibody-mediated rejection (ABMR). It is however unclear if the presence of pre-transplant donor specific antibodies (DSA) works as an additive risk factor in the setting of ABOi and if DSA positive ABOi transplants have a significantly worse long-term outcome as compared with ABO compatible (ABOc) DSA positive transplants.
We investigated the effect of pre-transplant DSA in the ABOi and ABOc setting on the risk of antibody-mediated rejection (ABMR) and graft loss in a cohort of 952 LD kidney transplants.
We found a higher incidence of ABMR in ABOi transplants as compared to ABOc transplants but this did not significantly affect graft survival or overall survival which was similar in both groups. The presence of pre-transplant DSA was associated with a significantly increased risk of ABMR and graft loss both in the ABOi and ABOc setting. We could not detect an additional risk of DSA in the ABOi setting and outcomes were comparable between DSA positive ABOi and ABOc recipients. Furthermore, a combination of DSA directed at both Class I and Class II, as well as DSA with a high mean fluorescence intensity (MFI) showed the strongest relation to ABMR development and graft loss.
The presence of pre-transplant DSA was associated with a significantly worse long-term outcome in both ABOi and ABOc LD kidney transplants and our results suggests that the risk associated with pre-transplant DSA is perhaps not augmented in the ABOi setting. Our study is the first to investigate the long-term effects of DSA in the ABOi setting and argues that pre-transplant DSA risk could potentially be evaluated similarly regardless of ABO compatibility status.
We investigated the effect of pre-transplant DSA in the ABOi and ABOc setting on the risk of antibody-mediated rejection (ABMR) and graft loss in a cohort of 952 LD kidney transplants.
We found a higher incidence of ABMR in ABOi transplants as compared to ABOc transplants but this did not significantly affect graft survival or overall survival which was similar in both groups. The presence of pre-transplant DSA was associated with a significantly increased risk of ABMR and graft loss both in the ABOi and ABOc setting. We could not detect an additional risk of DSA in the ABOi setting and outcomes were comparable between DSA positive ABOi and ABOc recipients. Furthermore, a combination of DSA directed at both Class I and Class II, as well as DSA with a high mean fluorescence intensity (MFI) showed the strongest relation to ABMR development and graft loss.
The presence of pre-transplant DSA was associated with a significantly worse long-term outcome in both ABOi and ABOc LD kidney transplants and our results suggests that the risk associated with pre-transplant DSA is perhaps not augmented in the ABOi setting. Our study is the first to investigate the long-term effects of DSA in the ABOi setting and argues that pre-transplant DSA risk could potentially be evaluated similarly regardless of ABO compatibility status.
摘要：
■在ABO血型不相容（ABOi）的情况下，活体供者（LD）肾移植先前已报道与抗体介导的排斥（ABMR）风险增加有关。然而，尚不清楚移植前供体特异性抗体（DSA）的存在是否在ABOi环境中作为累加风险因素起作用，以及与ABO兼容（ABOc）DSA阳性移植相比，DSA阳性ABOi移植的长期结果是否明显更差。
■我们研究了在ABOi和ABOc环境中移植前DSA对952例LD肾移植患者抗体介导的排斥反应（ABMR）和移植物丢失风险的影响。
■我们发现与ABOc移植相比，ABOi移植中ABMR的发生率更高，但这并没有显着影响移植物的存活率或总体存活率，两组相似。在ABOi和ABOc环境中，移植前DSA的存在与ABMR和移植物丢失的风险显着增加有关。我们无法在ABOi设置中检测到DSA的额外风险，并且DSA阳性ABOi和ABOc接受者之间的结局具有可比性。此外，针对I类和II类的DSA组合，以及具有高平均荧光强度（MFI）的DSA显示与ABMR发育和移植物丢失的关系最强。
■移植前DSA的存在与ABOi和ABOcLD肾移植的长期预后明显恶化相关，我们的结果表明，在ABOi情况下，与移植前DSA相关的风险可能没有增加。我们的研究是首次研究DSA在ABOi环境中的长期影响，并认为无论ABO相容性状态如何，移植前DSA风险都可以进行类似评估。
■我们研究了在ABOi和ABOc环境中移植前DSA对952例LD肾移植患者抗体介导的排斥反应（ABMR）和移植物丢失风险的影响。
■我们发现与ABOc移植相比，ABOi移植中ABMR的发生率更高，但这并没有显着影响移植物的存活率或总体存活率，两组相似。在ABOi和ABOc环境中，移植前DSA的存在与ABMR和移植物丢失的风险显着增加有关。我们无法在ABOi设置中检测到DSA的额外风险，并且DSA阳性ABOi和ABOc接受者之间的结局具有可比性。此外，针对I类和II类的DSA组合，以及具有高平均荧光强度（MFI）的DSA显示与ABMR发育和移植物丢失的关系最强。
■移植前DSA的存在与ABOi和ABOcLD肾移植的长期预后明显恶化相关，我们的结果表明，在ABOi情况下，与移植前DSA相关的风险可能没有增加。我们的研究是首次研究DSA在ABOi环境中的长期影响，并认为无论ABO相容性状态如何，移植前DSA风险都可以进行类似评估。
