活体捐赠者移植前的风险分层,通过不同的交叉匹配方法预先形成的捐赠者特异抗体的患者
Malte Ziemann1, Monika Lindemann2, Michael Hallensleben3
1Institute for Transfusion Medicine, University Hospital of Schleswig-Holstein, Lübeck, Germany.
Transplantation direct
|August 12, 2024
概括
流细胞计交叉匹配 (FXM) 有效地分层移植受体的风险,预先形成的捐赠者特异性HLA抗体 (DSA). 阴性FXM患者的结果与阴性DSA患者的结果相似,而阳性FXM患者面临更高的排斥率和减少的移植存活率.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學.
- 免疫学 免疫学 免疫学
- 移植科学 移植科学
背景情况:
- 预先形成的供体特异性HLA抗体 (DSA) 是移植的重要风险因素.
- 对DSA阳性患者的最佳风险分层仍在争论中.
- 有限的数据存在于DSA阳性移植接受者的各种交叉匹配测试的预后价值.
研究的目的:
- 为了评估不同交叉匹配测试在DSA阳性活体移植接受者的预后价值.
- 确定预形成DSA的患者最佳风险分层策略.
主要方法:
- 从4233例脏移植的多中心研究中,对44对捐赠者和接受者对进行了回顾性分析.
- 使用移植前血清进行了流量细胞计交叉匹配 (FXM),基于Luminex的交叉匹配和虚拟交叉匹配 (C1qXM,C3dXM).
- 收集了临床结果数据,包括10年死亡审查的移植存活率 (10yGS).
主要成果:
- 积极的交叉匹配率在19% (C3dXM) 到46% (FXM) 之间.
- 在交叉匹配阳性患者中观察到抗体介导排斥 (AMR) 的高发病率 (在B细胞FXM+中高达60%).
- 与DSA阴性和FXM阴性DSA阳性组相比,T细胞FXM和总FXM阳性患者的10yGS显著受损.
结论:
- 流细胞计交叉匹配 (FXM) 对DSA阳性移植受体的风险分层有价值.
- DSA阳性,FXM阴性患者表现出与DSA阴性患者相似的结果.
- 阳性FXM患者的AMR增加和移植存活率降低;对于较强的DSA病例,需要对Luminex,C1qXM和C3dXM进行进一步评估.
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