在ABO不兼容的移植中,抗体介导的排斥
Kai Castrezana Lopez1,2, Lukas Weidmann1, Dusan Harmacek1
1Division of Nephrology, University Hospital Zurich, Switzerland.
概括
与ABO不相容的移植显示出较低的抗体中介排斥率 (AMR) 和新的捐赠者特异性抗体 (DSA). 班夫2022标准可能会高估AMR,强调需要分子诊断来区分所有免疫损伤.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 移植免疫学 移植免疫学
- 免疫病理学 免疫病理学
背景情况:
- 在ABO不兼容 (ABOi) 移植中C4d沉积表明适应,而不是排斥.
- 针对血液组A/B抗原的捐赠者特异性抗体 (DSA) 是对ABOiAMR诊断的关键.
- 微血管炎症 (MVI) 是抗体介导排斥 (AMR) 的主要诊断标志物.
研究的目的:
- 评估 de novo 抗HLA DSA 在 ABOi 与 ABO 兼容 (ABOc) 移植受体 (KTR) 的发展.
- 为了将班夫2022分类与分子诊断 (MMDx) 进行比较,用于ABOi KTRs中的AMR.
- 调查C4d沉积在驱动分子AMR活性中的作用.
主要方法:
- 对抗HLA DSA的66个ABOi和251个ABOc KTR进行分析.
- 使用班夫2022标准对46个ABOi协议活检进行分类.
- 评估 25 个使用 MMDx 的 ABOi 协议活检,并将它们与不同类别的抗菌素耐药性的 ABOc 活检进行比较.
主要成果:
- 与ABOc KTR相比,ABOi KTR的新抗HLA DSA和临床AMR率较低.
- 在符合班夫AMR标准的ABOi活检中,MMDx仅在14%的ABOi活检中 (56%) 确认了分子AMR.
- 发现C4d沉积在ABOC活检中驱动分子AMR活性,即使没有组织学AMR诊断.
结论:
- ABOi移植与新兴抗HLA DSA发展的风险降低有关.
- 目前的班夫2022标准可能导致在ABOi移植中过度诊断AMR.
- 分子诊断对于区分免疫损伤与C4d沉积和准确评估AMR至关重要.
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