Antibody‐mediated rejections (AMR) in the absence of circulating anti‐HLA‐DSA have highlighted the role of non‐HLA antibodies, particularly those directed against endothelial cells. Of these, MICA (major histocompatibility complex class I chain–related molecule A) antibodies are the most notable and important because of their potential in promoting graft rejections. Limited studies have focused on the impact of MICA donor‐specific antibodies (DSA) on graft outcome as compared to those that are not donor‐specific (NDSA). We evaluated pre‐ and post‐transplant sera at POD 7, 30, 90, 180 and the time of biopsy from 206 consecutive primary live donor renal transplant recipients for anti‐MICA and anti‐HLA antibodies using single antigen bead assay on a Luminex platform. Recipients who developed MICA antibodies and their donors were phenotyped for MICA alleles. For the purpose of antibody analysis, patients were categorized into three major groups: biopsy‐proven AMR, acute cellular rejection (ACR) and those with no rejection episodes (NRE). During the mean follow‐up period of 17.37 ± 6.88 months, 16 of the 206 recipients developed AMR, while ACR was observed in only 13 cases. A quarter (25%) of the AMR cases had anti‐MICA antibodies as compared to 7.7% of those experiencing ACR and 6.2% of the NRE group. Allelic typing revealed that all MICA Ab +ve AMR cases were due to the presence of donor‐specific antibodies. MICA‐DSA even in the absence of HLA‐DSA was significantly associated with AMR but not with ACR when compared with the NRE group (P = <.01).

中文翻译：

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主要组织相容性复杂的I类链相关分子A（MICA）抗体在活体供体肾移植中的临床相关性-印度经验。

在缺乏循环抗HLA-DSA的情况下，抗体介导的排斥反应（AMR）突显了非HLA抗体的作用，尤其是针对内皮细胞的抗体。其中，MICA（主要组织相容性复杂的I类链相关的主要分子A）抗体是最著名和最重要的抗体，因为它们具有促进移植排斥的潜力。与非供体特异性（NDSA）相比，有限的研究集中于MICA供体特异性抗体（DSA）对移植物结果的影响。我们在Luminex平台上使用单抗原珠测定法评估了POD 7、30、90、180的移植前和移植后血清以及从206位连续的主要活体供肾移植接受者的活检时间中的抗MICA和抗HLA抗体。将开发出MICA抗体的接受者及其供体表型化为MICA等位基因。为了进行抗体分析，将患者分为三大类：活检证实的AMR，急性细胞排斥（ACR）和无排斥事件的患者（NRE）。在平均17.37±6.88个月的随访期间，206位接受者中有16位发生了AMR，而仅13例观察到了ACR。四分之一（25％）的AMR病例具有抗MICA抗体，而经历过ACR的病例为7.7％，而NRE组为6.2％。等位基因分型显示，所有MICA Ab + ve AMR病例均归因于供体特异性抗体的存在。与NRE组相比，即使没有HLA-DSA，MICA-DSA仍与AMR显着相关，但与ACR无关（将患者分为三大类：经活检证实的AMR，急性细胞排斥（ACR）和无排斥事件的患者（NRE）。在平均17.37±6.88个月的随访期间，206位接受者中有16位发生了AMR，而仅13例观察到了ACR。四分之一（25％）的AMR病例具有抗MICA抗体，而经历过ACR的病例为7.7％，而NRE组为6.2％。等位基因分型显示，所有MICA Ab + ve AMR病例均归因于供体特异性抗体的存在。与NRE组相比，即使没有HLA-DSA，MICA-DSA仍与AMR显着相关，但与ACR无关（将患者分为三大类：活检证实的AMR，急性细胞排斥（ACR）和无排斥事件的患者（NRE）。在平均17.37±6.88个月的随访期间，206位接受者中有16位发生了AMR，而仅13例观察到了ACR。四分之一（25％）的AMR病例具有抗MICA抗体，而经历过ACR的病例为7.7％，而NRE组为6.2％。等位基因分型显示，所有MICA Ab + ve AMR病例均归因于供体特异性抗体的存在。与NRE组相比，即使没有HLA-DSA，MICA-DSA仍与AMR显着相关，但与ACR无关（206位接受者中有16位发生了AMR，而仅13例观察到了ACR。四分之一（25％）的AMR病例具有抗MICA抗体，而经历过ACR的病例为7.7％，而NRE组为6.2％。等位基因分型显示，所有MICA Ab + ve AMR病例均归因于供体特异性抗体的存在。与NRE组相比，即使没有HLA-DSA，MICA-DSA仍与AMR显着相关，但与ACR无关（206位接受者中有16位发生了AMR，而仅13例观察到了ACR。四分之一（25％）的AMR病例具有抗MICA抗体，而经历过ACR的病例为7.7％，而NRE组为6.2％。等位基因分型显示，所有MICA Ab + ve AMR病例均归因于供体特异性抗体的存在。与NRE组相比，即使没有HLA-DSA，MICA-DSA仍与AMR显着相关，但与ACR无关（P  = <.01）。