一个潜在的多中心基于Luminex的临床算法,用于在移植之前定义不可接受的HLA不匹配. 对结果的后果,等待时间和等待名单的组成
Fabian Köppen1, Martina Koch2, Kai Lopau3
1Department of Nephrology, Regensburg University Hospital, Regensburg, Germany.
概括
标准化人类白细胞抗原 (HLA) 无法接受的不匹配 (UAM) 标准用于脏移植 (KT) 改善了短期结果,但导致更多高度敏感的患者等待移植.
科学领域:
- 免疫学 免疫学 免疫学
- 移植医学 移植医学
- 腎臟病學 (nephrology) 是一種醫學專業.
背景情况:
- 移植 (KT) 需要通过人类白细胞抗原 (HLA) 不匹配评估来最大限度地降低免疫风险.
- 目前的Luminex单抗原珠 (SAB) 对不可接受不匹配 (UAM) 的测试往往缺乏标准化的标准.
- 标准化对于公平有效的器官分配至关重要.
研究的目的:
- 在德国移植中心实施和评估基于平均光强度 (MFI) 的标准化SAB-UAM标准.
- 评估标准化标准对等候名单组成,等待时间和移植后结果的影响.
- 分析早期抗体中介排斥 (AMR) 和移植损失率.
主要方法:
- 在德国四个移植中心对267名接受KT治疗的患者进行前性研究.
- 实施标准化的MFI截止值 (大多数HLA的5,000,HLA DQ的10,000) 来确定UAM.
- 评估等待名单组成,等待时间,AMR和移植存活率.
主要成果:
- 观察到等待名单上大量的高度敏感的患者 (虚拟面板反应率>95%) 在等待名单上.
- 虽然在UAM患者中,KT的中位时间较长,但差异在统计学上并不显著.
- 低于UAM标准的预形成的供体特异性抗HLA抗体 (DSA) 的患者与DSA阴性患者 (1.3%) 相比,显示AMR率更高 (10.3%).
- 在4年的中位数随访期间,移植存活率没有显著差异.
结论:
- 标准化的SAB-UAM标准与移植的良好短期结果有关.
- 标准化标准的实施导致等候名单上高度敏感的患者比例增加.
- 根据标准化的UAM协议,可能需要进一步的策略来管理高度敏感的患者的等待列表.
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