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JASN:供体特异性抗体对肾移植结果有负面影响

2012-12-12 JASN JASN

特异性抗体供体肾移植流式细胞术队列研究Meta分析阴性DASs
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     目前关于敏感固相试验（SPAs）检测到的低定量供体特异性抗体（DSAs）对肾移植结果的影响仍然不清楚。来自哥伦比亚大学的研究者进行系统回顾和meta分析后发现，移植排异患者SPA显现出了阳性结果，而补体依赖性细胞毒和流式细胞术试验却是阴性结果。 　　研究者运用了7个回顾性队列研究，包括1119名患者，其中145位具有独立的DSA-SPA。尽管流式细胞术试验

     目前关于敏感固相试验（SPAs）检测到的低定量供体特异性抗体（DSAs）对肾移植结果的影响仍然不清楚。来自哥伦比亚大学的研究者进行系统回顾和meta分析后发现，移植排异患者SPA显现出了阳性结果，而补体依赖性细胞毒和流式细胞术试验却是阴性结果。

　　研究者运用了7个回顾性队列研究，包括1119名患者，其中145位具有独立的DSA-SPA。尽管流式细胞术试验结果是阴性，但是DSA-SPA的存在预示着2倍的抗体介导的排异反应风险（RR=1.98；95%CI，1.36-2.89；P<0.001），同时移植失败的风险增加了76%（RR=1.76；95%CI，1.13-2.74；P<0.01）。

　　结果预示着，肾移植供体的选择应当需要考虑通过SPA确定受捐者抗体是否存在特异性抗体，即使是流式细胞术试验结果阴性。



Abstract
The effect of low titers of donor-specific antibodies (DSAs) detected only by sensitive solid-phase assays (SPAs) on renal transplant outcomes is unclear. We report the results of a systematic review and meta-analysis of rejection rates and graft outcomes for renal transplant recipients with such preformed DSAs, defined by positive results on SPA but negative complement-dependent cytotoxicity and flow cytometry crossmatch results. Our search identified seven retrospective cohort studies comprising a total of 1119 patients, including 145 with isolated DSA-SPA. Together, these studies suggest that the presence of DSA-SPA, despite a negative flow cytometry crossmatch result, nearly doubles the risk for antibody-mediated rejection (relative risk [RR], 1.98; 95% confidence interval [CI], 1.36-2.89; P<0.001) and increases the risk for graft failure by 76% (RR, 1.76; 95% CI, 1.13-2.74; P=0.01). These results suggest that donor selection should consider the presence of antibodies in the recipient, identified by the SPA, even in the presence of a negative flow cytometry crossmatch result
    

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    2013-11-24 feather85

    #供体#

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    2013-06-19 jinweidong

    #特异性#

    0

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    2013-06-07 chenhongpeng

    #ASN#

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    2013-04-28 d830372

    #负面影响#

    0

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    2012-12-14 hyf032

    #特异性抗体#

    0