高风险的HLA-DQ不匹配与肺移植后的不良结果有关
Lisa Kleid1, Julia Walter2,3,4, Patrick Moehnle1
1Division of Transfusion Medicine, Cell Therapeutics and Haemostaseology, University Hospital, LMU Munich, Munich, Germany.
概括
人类白细胞抗原 (HLA) 不匹配增加了肺移植后发展供体特异性抗体 (dnDSA) 的风险. HLA-DQ同胞性和特异性乳皮不匹配是HLA-DQ-dnDSA的关键风险因素,影响了移植结果.
科学领域:
- 免疫遗传学 免疫遗传学
- 移植免疫学 移植免疫学
- 基因组医学是基因组医学.
背景情况:
- 人类白细胞抗原 (HLA) 与捐赠者和接受者之间的不匹配在肺移植 (LTX) 中至关重要.
- 由HLA不匹配引起的表皮细胞不匹配 (epMM) 可以触发de-novo捐赠者特定的HLA抗体 (dnDSA),特别是HLA-DQ-dnDSA.
研究的目的:
- 确定与肺移植受体中HLA-DQ-dnDSA的发展相关的特定风险因素.
- 评估HLA-DQ-dnDSA对急性细胞排斥 (ACR),慢性肺异位移植功能障碍 (CLAD) 和患者存活率的临床影响.
主要方法:
- 对183名LTX患者 (2012-2020年) 具有11位点HLA类型的回顾性分析.
- 使用HLAMatchmaker软件计算eplet不匹配 (epMM) 的结果.
- 在LTX后1年内监测dnDSA的发展,使用Chi2测试,学生t测试,卡普兰-梅尔曲线和多变量考克斯回归进行统计比较.
主要成果:
- 22.9%的患者发生了HLA-DQ-dnDSA.
- HLA-DQ同卵性接受者患HLA-DQ-dnDSA的风险明显更高 (p=0.03).
- 在同卵性接受者中,特定的DQ-eplet组合和HLA-DQB1*03:01与增加的HLA-DQ-dnDSA风险有关,这与较高的ACR和CLAD率相关.
结论:
- HLA-DQ同性和特定高风险的DQ-epMM是LTX中HLA-DQ-dnDSA发展的重要预测因素.
- HLA-DQ-dnDSA的发展对移植结果产生了负面影响,增加了ACR和CLAD.
- 将这些发现纳入临床实践可以增强免疫学兼容性并改善LTX移植结果.
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