Pre-transplant Screening for Non-HLA Antibodies: Who should be Tested?

被引:31
作者
Philogene, Mary Carmelle [1 ]
Zhou, Sheng [2 ,3 ]
Lonze, Bonnie E. [4 ]
Bagnasco, Serena [5 ]
Alasfar, Sami [1 ]
Montgomery, Robert A. [4 ]
Kraus, Edward [1 ]
Jackson, Annette M. [1 ]
Leiffell, Mary S. [1 ]
Zachary, Andrea A. [1 ]
机构
[1] Johns Hopkins Univ, Sch Med, Dept Med, Baltimore, MD 21205 USA
[2] Johns Hopkins Univ, Sch Med, Dept Surg, Baltimore, MD 21205 USA
[3] Johns Hopkins Sch Publ Hlth, Dept Epidemiol, Baltimore, MD USA
[4] NYU, Dept Surg, Langone Transplant Inst, New York, NY 10016 USA
[5] Johns Hopkins Univ, Sch Med, Dept Pathol, Baltimore, MD 21205 USA
关键词
Anti-endothelial cell antibodies; Non-HLA antibodies; Angiotensin II type 1 receptor antibody; High immunologic risk patients; Kidney allograft dysfunction; II TYPE-1 RECEPTOR; MHC CLASS-I; ANGIOTENSIN-II; KIDNEY-TRANSPLANTATION; MEDIATED REJECTION; ALLOGRAFT SURVIVAL; ENDOTHELIAL-CELLS; RECIPIENTS; FAILURE; PATHWAY;
D O I
10.1016/j.humimm.2018.02.001
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Retrospective studies of angiotensin II type 1 receptor antibodies (AT1R-Ab) and anti-endothelial cell antibodies (AECA) have linked these antibodies to allograft injury. Because rising healthcare costs dictate judicious use of laboratory testing, we sought to define characteristics of kidney transplant recipients who may benefit from screening for non-HLA antibodies. Kidney recipients transplanted between 2011 and 2016 at Johns Hopkins, were evaluated for AT1R-Ab and AECA. Pre-transplant antibody levels were compared to clinical and biopsy indications of graft dysfunction. Biopsies were graded using the Banff 2009-2013 criteria. AT1R-Ab and AECA were detected using ELISA and endothelial cell crossmatches, respectively. AT1R-Ab levels were higher in patients who were positive for AECAs. Re-transplanted patients (p < 0.0001), males (p = 0.008) and those with FSGS (p = 0.04) and younger (p = 0.04) at time of transplantation were more likely to be positive for AT1R-Ab prior to transplantation. Recipients who were positive for AT1R-Ab prior to transplantation had increases in serum creatinine within 3 months post-transplantation (p < 0.0001) and developed abnormal biopsies earlier than did AT1R-Ab negative patients (126 days versus 368 days respectively; p = 0.02). Defining a clinical protocol to identify and preemptively treat patients at risk for acute rejection with detectable non-HLA antibodies is an important objective for the transplant community.
引用
收藏
页码:195 / 202
页数:8
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