肾移植受者的补体结合供体特异性人类白细胞抗原(HLA)抗体与同种异体移植排斥和丢失的高风险相关。这项荟萃分析的目的是研究C1q结合供体特异性抗体(DSA)与肾移植(KT)受者临床结局之间的相关性。
我们在PubMed中进行了系统搜索,EMBASE,和CochraneLibrary数据库,以确定自开始至2021年8月的所有研究,这些研究比较了接受KT的C1q+DSA和C1q-DSA患者的临床结局。数据由评估偏倚风险的两名审阅者独立提取。根据异质性,采用固定效应或随机效应模型对数据进行汇总。我们评估了临床结果,包括移植物丢失,拒绝,延迟移植物功能(DGF),以及全因患者死亡。
共纳入26项研究,共1337例患者:485例C1q结合DSA,和850没有C1q结合DSA。与C1q-DSA组相比,C1q+DSA组抗体介导的排斥反应(AMR)显著增加(相对危险度[RR]=2.09,95%置信区间[CI],1.53-2.86;P<0.00001),移植物丢失(RR=2.40,95%CI,1.66-3.47;P<0.00001),和死亡(RR=3.13,95%CI,1.06-9.23;P=0.04)。C1q+DSA和C1q-DSA组在T细胞介导的排斥反应中没有显示显著差异,急性排斥反应,急性细胞排斥反应,混合排斥,或DGF。
这项系统评价的结果表明,C1q+DSAKT具有较高的AMR风险,移植物丢失,与C1q-DSA患者相比死亡。监测C1q结合DSA可以对接受者进行风险分层并指导医生管理。
Complement-binding donor-specific human leukocyte antigen (HLA) antibodies in kidney recipients have been associated with a higher risk of allograft rejection and loss. The objective of this meta-analysis was to investigate the correlation between C1q-binding donor-specific antibodies (DSAs) and clinical outcomes in kidney transplantation (KT) recipients.
We conducted systematic searches in the PubMed, EMBASE, and the Cochrane Library databases to identify all studies since inception to August 2021 that compared clinical outcomes between C1q + DSA and C1q-DSA patients who underwent KT. Data were independently extracted by two reviewers who assessed the risk of bias. Data were summarized with fixed effects or random effects models according to heterogeneity. We assessed clinical outcomes including graft loss, rejection, delayed graft function (DGF), and all-cause patient death.
Twenty-six studies with a total of 1337 patients were included: 485 with C1q-binding DSAs, and 850 without C1q-binding DSAs. Compared with the C1q-DSA group, the C1q + DSA group had significant increases in antibody-mediated rejection (AMR) (relative risk [RR] = 2.09, 95% confidence interval [CI], 1.53-2.86; P < 0.00001), graft loss (RR = 2.40, 95% CI, 1.66-3.47; P < 0.00001), and death (RR = 3.13, 95% CI, 1.06-9.23; P = 0.04). The C1q + DSA and C1q-DSA groups did not show significant differences in T-cell-mediated rejection, acute rejection, acute cellular rejection, mixed rejection, or DGF.
The findings of this systematic
review suggest that C1q + DSA KT have a higher risk of AMR, graft loss, and death compared with C1q-DSA patients. Monitoring C1q-binding DSAs allows risk stratification of recipients and guides physician management.