Abstract:

Objective To investigate the relationship between the average fluorescence intensity and the type of donor-specific antibody （DSA）detected by monoclonal antibody in the sensitized patients before renal transplantation and the early anti-mediated rejection. Methods We retrospectively analyzed the data of 30 sensitized renal transplantation patients from 2012 January to 2014 January in Tianjin First Center hospital. We detected preoperative donor specific antibody using a Luminex platform and analyzed the clinical impact of antibody type and the mean fluorescence intensity（MFI） to early postoperative antibody mediated rejection （AMR）. Results Twenty-two patients had pretransplant DSA， and there were 9 cases of type Ⅰ positive, 7 cases of type Ⅱ positive，6 cases had class Ⅰ and Ⅱ，10 cases （45.5%） had antibody mediated rejection. Comparison AMR positive group with AMR negative group， class Ⅰ DSA MFI and class Ⅰ strong positive DSA （MFI ≥ 8 000） had significant difference （P ＜ 0.05） between the two groups， but the levels of PRA and class Ⅱ DSA had no significant difference （all P ＞ 0.05）. In 7 patients with class Ⅰ strong positive DSA，6 patients （85.7%） had AMR， but in8 cases with class Ⅰ moderate positive DSA （1 000 ＜ MFI ＜ 8 000），2 cases （25%） had AMR， there were statistical difference （P ＜ 0.05）. Preoperative class Ⅰ strong positive DSA had a positive predictive value of 85.7% and a negative predictive value of 75%， and the sensitivity and specificity of AMR was 75% and 85.7%，respectively. Conclusion Preoperative avoidance of strongly positive class Ⅰ DSA can increase the chance of renal transplantation in sensitized patients and reduce the incidence of early postoperative AMR. Preoperative patientspecific antibody stratification analysis can increase the chance of renal transplantation in sensitized patients.