固体器官移植中的补充依赖性细胞毒性交叉匹配:黄金标准还是黄金历史?
Sandra Tafulo1, Ermelinda Osório2, Cecília Mendes2
1Centro de Sangue e da Transplantação do Porto, Instituto Português do Sangue e da Transplantação, Porto, Portugal; UMIB - Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal.
Human immunology
|November 29, 2023
概括
补充依赖性细胞毒性交叉匹配 (CDC-XM) 对固体器官移植的兼容性是不可靠的,显示高假阳性和低敏感性. 在虚拟交叉匹配 (vXM) 时代,这种方法可能会阻碍安全及及时的移植分配.
科学领域:
- 免疫学 免疫学 免疫学
- 移植科学 移植科学
- 临床病理学 临床病理学
背景情况:
- 补充依赖性细胞毒性交叉匹配 (CDC-XM) 是固体器官移植 (SOT) 兼容性的传统标准.
- 疾病预防控制中心-XM是艰苦的,耗时的,缺乏敏感性和特异性.
- 流细胞计交叉匹配 (FCXM) 和虚拟交叉匹配 (vXM) 在全球范围内越来越多地取代了CDC-XM.
研究的目的:
- 评估在当前基于vXM的分配时代执行CDC-XM的相关性.
- 与vXM和抗体检测相比,评估CDC-XM的敏感性和特异性.
主要方法:
- 对1007个连续的T和B细胞死亡供体 (DD) CDC-XMs进行了回顾性分析.
- 进行了CDC-XM,使用未经治疗的和用dithiothreitol (DTT) 治疗的血清.
- 与虚拟交叉匹配 (vXM) 的比较和对捐赠者特定抗体 (DSA) 的检测.
主要成果:
- 观察到高比例的错误阳性CDC-XMs:3.5%的T细胞和13.1%的B细胞测试呈阳性,未经治疗的血清.
- DTT治疗显著降低了阳性CDC-XM,证实了高假阳性反应性.
- 疾病预防控制中心-XM对I类HLA DSA对C位点的敏感度为0%,对针对HLA-C,DQ和/或DP抗原的DSA敏感度为7.8%.
结论:
- 疾病预防控制中心-XM具有较低的灵敏度和高的错误阳性率,特别是在没有DTT治疗的情况下.
- 当使用vXM时,CDC-XM对移植前的兼容性测试没有显著的贡献.
- 继续使用CDC-XM可能会不必要地推迟或阻止适当和安全的移植分配.
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