这项研究调查了高度敏感的患者在实施除名策略后的肾移植结果,该策略旨在尽管预先形成了供体特异性抗体(preDSA),目的是降低急性抗体介导的排斥反应(aAMR)风险。53名致敏受者在删除禁用的HLA抗原后接受了肾脏移植,最初集中在低MFI抗体(<5000),除了抗HLA-DQ.如果不够,允许更高的MFI抗体,特别是对于那些没有分配免疫原性eplet模式的人。始终避免了补体固定抗体(C1q+)的除名。比较队列包括53名无DSA(SwoDSA)的致敏受者和53名非致敏受者(NS)。除名前的平均等待时间为4.4±1.8年,cPRA从99.7±0.5降至98.1±0.7,随后在7.2±8.0个月内进行移植(分析34例患者)。preDSA之间的拒绝率相似,SwoDSA,和NS组(16%,8%,11%,分别为;p=0.46)。然而,aAMR在preDSA组中较高(12%,4%,2%,分别为;p=0.073),仅在DSAMFI>5000的收件人中出现。最高的MFIDSA是针对HLA-DP(中位数:10796MFI),50%的preDSAaAMR病例归因于抗DP抗体(n=3)。前DSA组1年和5年的移植物存活率为94%,67%,与SwoDSA(94%,和70%;p=0.69),在NS组中明显更高(p=0.002)。受者的五年生存率为89%,与SwoDSA和NS组相当(p=0.79)。除名策略可以在患有前DSA的高度敏感患者中进行安全的肾脏移植,aAMR略有增加,与非DSA队列的移植物和患者生存率相当。
This study investigates kidney transplant outcomes in highly sensitised patients after implementing a delisting strategy aimed at enabling transplantation despite preformed donor-specific antibodies (preDSA), with the goal of reducing acute antibody-mediated rejection (aAMR) risk. Fifty-three sensitised recipients underwent kidney transplant after delisting prohibited HLA antigens, focusing initially in low MFI antibodies (<5000), except for anti-HLA-DQ. If insufficient, higher MFI antibodies were permitted, especially for those without an immunogenic eplet pattern assigned. Delisting of Complement-fixing antibodies (C1q+) was consistently avoided. Comparison cohorts included 53 sensitised recipients without DSA (SwoDSA) and 53 non-sensitised (NS). The average waiting time prior to delisting was 4.4 ± 1.8 years, with a reduction in cPRA from 99.7 ± 0.5 to 98.1 ± 0.7, followed by transplantation within 7.2 ± 8.0 months (analysed in 34 patients). Rejection rates were similar among preDSA, SwoDSA, and NS groups (16%, 8%, and 11%, respectively; p = 0.46). However, aAMR was higher in the preDSA group (12%, 4%, and 2%, respectively; p = 0.073), only presented in recipients with DSA of MFI >5000. The highest MFI DSA were against HLA-DP (Median: 10796 MFI), with 50% of preDSA aAMR cases due to anti-DP antibodies (n = 3). Graft survival rates at 1 and 5 years in preDSA group were 94%, and 67%, comparable to SwoDSA (94%, and 70%; p = 0.69), being significantly higher in the NS group (p = 0.002). The five-year recipient survival rate was 89%, comparable to SwoDSA and NS groups (p = 0.79). A delisting strategy enables safe kidney transplant in highly sensitised patients with preDSA, with a slight increase in aAMR and comparable graft and patient survivals to non-DSA cohorts.