Background

Donor-specific antibodies are associated with high immunological risk and poor allograft outcome. Risk and clinical relevance of non-donor-specific HLA antibodies is less clear.

Methods

A retrospective single-center study was conducted in all patients receiving a first kidney transplant at the University hospital of Zürich between 01/2006 and 02/2015. Patients were stratified into 3 groups having either no HLA antibodies at all (NoAB), HLA antibodies with donor specificity (DSA) and HLA antibodies without donor specificity (NonDSA). Allograft outcome was assessed using the slope of the estimated glomerular filtration rate (eGFR slope) starting at 12 months after transplantation.

Results

During a median follow-up of 1808 days HLA antibodies were detected in 106 of 238 eligible patients (44%). Out of these, 73 patients (69%) had DSA and 33 patients (31%) had NonDSA only. Medium-term allograft function, as determined by eGFR slope over three years, improved in patients with NoAB (months 12–48: +0.7 ml/min/1.73 m²) but deteriorated significantly in patients with both DSA (months 12–48: −1.5 ml/min per1.73 m²/year, p = 0.015) and NonDSA (months 12–48: −1.8 ml/min per1.73 m²/year, p = 0.03) as compared to the group with NoAB.

Conclusion

Both, donor-specific and non-donor-specific HLA antibodies are associated with medium-term kidney allograft dysfunction as compared to patients with no HLA antibodies.

中文翻译：

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无论供体特异性如何，HLA 抗体都与同种异体肾功能的恶化有关

背景

供体特异性抗体与高免疫风险和较差的同种异体移植结果相关。非供体特异性 HLA 抗体的风险和临床相关性尚不清楚。

方法

一项回顾性单中心研究在 2006 年 1 月至 2015 年 2 月 2 日期间在苏黎世大学医院接受第一次肾移植的所有患者中进行。患者被分为完全没有 HLA 抗体 (NoAB)、具有供体特异性的 HLA 抗体 (DSA) 和没有供体特异性的 HLA 抗体 (NonDSA) 的 3 组。使用移植后 12 个月开始的估计肾小球滤过率斜率（eGFR 斜率）评估同种异体移植结果。

结果

在 1808 天的中位随访期间，238 名符合条件的患者中有 106 名（44%）检测到 HLA 抗体。其中，73 名患者 (69%) 患有 DSA，33 名患者 (31%) 仅患有 NonDSA。根据三年的 eGFR 斜率确定的中期同种异体移植功能在 NoAB 患者中有所改善（第 12-48 个月：+0.7 ml/min/1.73 m ²），但在两种 DSA 患者中均显着恶化（第 12-48 个月： -1.5 ml/min per1.73 m ² /年，p = 0.015）和 NonDSA（第 12-48 个月：-1.8 ml/min per1.73 m ² /年，p = 0.03）与 NoAB 组相比。

结论

与没有 HLA 抗体的患者相比，供体特异性和非供体特异性 HLA 抗体都与中期移植肾功能障碍有关。