Posttransplant De Novo Donor-Specific HLA Antibodies Identify Pediatric Kidney Recipients at Risk for Late Antibody-Mediated Rejection

被引：146

作者：

Ginevri, F. ^{[1
]}

Nocera, A. ^{[2
]}

Comoli, P. ^{[3
]}

Innocente, A. ^{[4
]}

Cioni, M. ^{[1
]}

Parodi, A. ^{[5
]}

Fontana, I. ^{[2
]}

Magnasco, A. ^{[1
]}

Nocco, A. ^{[4
]}

Tagliamacco, A. ^{[2
]}

Sementa, A. ^{[1
]}

Ceriolo, P. ^{[1
]}

Ghio, L. ^{[4
]}

Zecca, M. ^{[3
]}

Cardillo, M. ^{[4
]}

Garibotto, G. ^{[6
]}

Ghiggeri, G. M. ^{[1
]}

Poli, F. ^{[4
]}

机构：

[1] Ist Giannina Gaslini, I-16148 Genoa, Italy

[2] Ist Nazl Ric Canc, IRCCS Azienda Osped Univ S Martino, Dept Transplant Surg, I-16132 Genoa, Italy

[3] Fdn Policlin S Matteo, Pavia, Italy

[4] Fdn Ca Granda Osped Maggiore Policlin, Milan, Italy

[5] Osped Presidio Sestri Levante, Nephrol Unit, Genoa, Italy

[6] Univ Genoa, Dept Internal Med, IRCCS Azienda Osped Univ S Martino Hosp, Ist Nazl Ric Canc, I-16126 Genoa, Italy

来源：

AMERICAN JOURNAL OF TRANSPLANTATION | 2012年 / 12卷 / 12期

关键词：

Antibody-mediated rejection; de novo anti-HLA antibodies; microarray bead-based assay; pediatric kidney transplantation; HUMAN-LEUKOCYTE ANTIGEN; TRANSPLANTATION; ALLOANTIBODIES; FAILURE; TIME;

D O I：

10.1111/j.1600-6143.2012.04251.x

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

The emerging role of humoral immunity in the pathogenesis of chronic allograft damage has prompted research aimed at assessing the role of anti-HLA antibody (Ab) monitoring as a tool to predict allograft outcome. Data on the natural history of allografts in children developing de novo Ab after transplantation are limited. Utilizing sera collected pretransplant, and serially posttransplant, we retrospectively evaluated 82 consecutive primary pediatric kidney recipients, without pretransplant donor-specific antibodies (DSA), for de novo Ab occurrence, and compared results with clinicalpathologic data. At 4.3-year follow up, 19 patients (23%) developed de novo DSA whereas 24 had de novo non-DSA (NDSA, 29%). DSA appeared at a median time of 24 months after transplantation and were mostly directed to HLA-DQ antigens. Among the 82 patients, eight developed late/chronic active C4d+ antibody-mediated rejection (AMR), and four C4d-negative AMR. Late AMR correlated with DSA (p < 0.01), whose development preceded AMR by 1-year median time. Patients with DSA had a median serum creatinine of 1.44 mg/dL at follow up, significantly higher than NDSA and Ab-negative patients (p < 0.005). In our pediatric cohort, DSA identify patients at risk of renal dysfunction, AMR and graft loss; treatment started at Ab emergence might prevent AMR occurrence and/or progression to graft failure.

引用

页码：3355 / 3362

页数：8

共 30 条

[1] Development of nondonor-specific HLA-DR antibodies in allograft recipients is associated with shared epitopes with mismatched donor DR antigens [J].