Background

The presence of donor-specific antibodies (DSAs) against HLA-DQB1 is considered a significant barrier to good outcome and allograft survival in kidney transplantation (KT). This study aimed to assess the impact of induction immunotherapy on the outcome and allograft survival in KT patients with HLA-DQB1-DSA.

Methodology

Thirty-two patients who had undergone KT and found to be positive for HLA-DQB1-DSA were monitored at least one to 10 years. They were allocated into two groups of patients: G1 received induction immunotherapy (n = 14 patients; 43.75%), and G2 did not (n = 18 patients; 56.25%).

Results

In G1, 6 (42.86%) patients experienced rejection episodes (RE), 2 (14.29%) due to antibody-mediated rejection (ABMR) and 4 (28.57%) due to T-cell-mediated rejection (TCMR). In G2, 13 (72.22%) patients experienced RE, 3 (16.67%) due to ABMR, and 10 (55.56%) due to TCMR. Graft loss occurred in 4 patients from G1, 2 (14.29%) due to ABMR and 2 (14.29%) due to non-immunological causes. In G2, 9 (50.00%) patients lost their grafts, 2 (11.11%) due to TCMR, 2 (11.11%) due to ABMR, and 5 (27.78%) due to non-immunological causes. The graft survival rate was 64.29% in G1 and 45.83% in G2. Glomerulitis and peritubular capillaritis were observed in 3 and C4d-positive patients with/or without induction who lost their grafts by ABMR by HLA-DQ DSA. Two patients from G2 lost their graft by TCMR due to interstitial lymphocytic infiltrate (i1), foci of mild tubulitis (t2), interstitial edema, moderate interstitial fibrosis and tubular atrophy. Better graft survival rates were shown in patients from G1 who received induction immunotherapy.

Conclusion

Our study suggests that patients with an immunological profile of HLA-DQ+ DSA+ treated by immunotherapy induction have a decreased risk of ABMR and increased allograft survival, and the presence of anti-HLA-DQB1 DSA+ detected before and after KT were associated with ABMR episodes and failure.

中文翻译：

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免疫治疗诱导对具有 HLA-DQB1 供体特异性抗体的肾移植患者同种异体移植结果和存活率的影响

背景

针对 HLA-DQB1 的供体特异性抗体 (DSA) 的存在被认为是肾移植 (KT) 中良好结果和同种异体移植存活的重要障碍。本研究旨在评估诱导免疫治疗对 HLA-DQB1-DSA 的 KT 患者的预后和同种异体移植存活率的影响。

方法

32 名接受 KT 并发现 HLA-DQB1-DSA 呈阳性的患者接受了至少 1 到 10 年的监测。他们被分为两组患者：G1 接受诱导免疫治疗（n = 14 名患者；43.75%），而 G2 未接受（n = 18 名患者；56.25%）。

结果

在 G1 中，6 名 (42.86%) 患者出现排斥反应 (RE)，2 名 (14.29%) 由于抗体介导的排斥 (ABMR) 和 4 名 (28.57%) 由于 T 细胞介导的排斥 (TCMR)。在 G2 中，13 名 (72.22%) 患者出现 RE，3 名 (16.67%) 因 ABMR，10 名 (55.56%) 因 TCMR。从 G1 开始，4 名患者发生移植物丢失，其中 2 名 (14.29%) 由于 ABMR，2 名 (14.29%) 由于非免疫原因。在 G2 中，9 名 (50.00%) 患者失去移植物，2 名 (11.11%) 因 TCMR，2 名 (11.11%) 因 ABMR，5 名 (27.78%) 由于非免疫原因。移植物成活率 G1 为 64.29%，G2 为 45.83%。在 3 和 C4d 阳性患者中观察到肾小球炎和管周毛细血管炎，这些患者有/或没有诱导，他们通过 HLA-DQ DSA 的 ABMR 丢失了移植物。由于间质淋巴细胞浸润，来自 G2 的两名患者通过 TCMR 失去了移植物（i1），轻度肾小管炎病灶（t2）、间质水肿、中度间质纤维化和肾小管萎缩。接受诱导免疫治疗的 G1 患者显示出更好的移植物存活率。

结论

我们的研究表明，接受免疫疗法诱导治疗的具有 HLA-DQ+ DSA+ 免疫学特征的患者发生 ABMR 的风险降低并增加同种异体移植物存活率，并且在 KT 前后检测到的抗 HLA-DQB1 DSA+ 的存在与 ABMR 发作和失败。