BACKGROUND The longitudinal relationship between HLA class I and II eplet mismatches, de novo donor-specific antibodies (dnDSA) development, and acute rejection after transplantation in childhood is unknown. METHODS Eplet mismatches at HLA class I and II loci were calculated retrospectively for each donor/recipient pair transplanted between 2005 and 2015 at a single Australian center. Logistic regression analyses were conducted to determine the association between the number of eplet mismatches, dnDSA, and acute rejection. RESULTS The cohort comprised 59 children (aged 0-18 years) who received their first kidney allograft and were followed for median (interquartile range) 4.5 (± 2.6) years. Overall, 32% (19/59) developed dnDSA (class I 3% (2/59), class II 14% (8/59), 15% class I and II (9/59)), and 24% (14/59) developed biopsy-proven acute rejection. Every unit increase in class I and II eplet mismatches corresponded to an increase in risk of class I (odds ratio (OR) 1.22, 95% CI 1.07-1.39, p < 0.01) and class II (OR 1.06, 95% CI 1.01-1.11, p = 0.02) dnDSA development. Compared with recipients without dnDSA, class I and II dnDSA were associated with direction of effect towards increased risk of acute cellular rejection (class I: OR 5.87, 95% CI 0.99-34.94, p = 0.05; class II: OR 12.00, 95% CI 1.25-115.36, p = 0.03) and acute antibody-mediated rejection (class I: OR 25.67, 95% CI 3.54-186.10, p < 0.01; class II: OR 9.71, 95% CI 1.64-57.72, p = 0.01). CONCLUSIONS Increasing numbers of HLA class I or II eplet mismatches were associated with the development of dnDSA. Children who developed dnDSA were also more likely to develop acute rejection compared with children without dnDSA.

中文翻译：

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小儿肾移植受者中人白细胞抗原小片段错配，从头供体特异性抗体与急性排斥反应的风险之间的关联。

背景技术HLA I类和II类eplet错配，新生供体特异性抗体（dnDSA）发育以及儿童移植后的急性排斥反应之间的纵向关系尚不清楚。方法回顾性分析2005年至2015年间在单个澳大利亚中心移植的每个供体/受体对的HLA I级和II级基因座的表位失配。进行logistic回归分析以确定eplet不匹配数，dnDSA和急性排斥反应之间的关联。结果该队列包括59名儿童（0-18岁），他们接受了首次同种异体肾移植，并接受了中位（四分位间距）4.5（±2.6）岁的随访。总体而言，有32％（19/59）开发了dnDSA（I类3％（2/59），II类14％（8/59），I类和II类15％（9/59）），24％（14/59）的患者经活检证实为急性排斥反应。I和II类eplet不匹配的每增加一个单位，对应于I类（优势比（OR）1.22，95％CI 1.07-1.39，p <0.01）和II类（OR 1.06，95％CI 1.01-）的风险增加。 1.11，p = 0.02）dnDSA开发。与没有dnDSA的接受者相比，I和II类dnDSA与增加急性细胞排斥风险的作用方向相关（I类：OR 5.87，95％CI 0.99-34.94，p = 0.05； II类：OR 12.00，95％ CI 1.25-115.36，p = 0.03）和急性抗体介导的排斥反应（I类：OR 25.67，95％CI 3.54-186.10，p <0.01； II类：OR 9.71，95％CI 1.64-57.72，p = 0.01） 。结论HLA I类或II类HLA错配越来越多与dnDSA的发展有关。