Abstract:

Objective To investigate non-HLA antibodies characteristics and its relationship with graft pathology after renal transplantation. Methods Non-HLA antibody data of 444 recipients after renal transplantation from 2016 to 2022 were retrospectively analyzed， the recipients were divided into rejection group （47 cases）， nonrejection group （61 cases）， and stable renal function group （336 cases） according to the pathological diagnosis of grafts. GraphPad Prism 9.0 was used to analyze the characteristics of non-HLA antibodies after kidney transplantation， the correlation between non-HLA antibodies and HLA antibodies， and the relationship between non-HLA antibodies and thepathological state of the renal allograft. Results Among the 444 recipients，310 cases （69.8%） were positive for nonHLA antibodies， which was positively correlated with HLA antibodies （r ＝ 0.606，P ＜ 0.001）. The median of MFIvalue and the median multiple of the threshold value of non-HLA antibodies in recipients with positive HLA antibodies was higher than that in recipients with negative HLA antibodies post-transplant. There were differences in common nonHLA antibodies among rejection group， non-rejection group and renal function stable group. Non-HLA antibodies were positively correlated with chronic glomerulopathy （r ＝ 0.186，P ＝ 0.033） and interstitial fibrosis （r ＝ 0.265，P ＝ 0.002）. Receiver operating characteristic curve （ROC） analysis showed that non-HLA antibodies were highly predictive of allograft arteritis （AUC ＝ 0.771）and chronic nephropathy （AUC ＝ 0.741）， but were not good at predicting rejection （AUC ＝0.605）. ConclusionThe positive rate of non-HLA antibodies was higher after renal transplantation. The common non-HLA antibodies in recipients with rejection， non-rejection and stable renal allograft function are different. Non-HLAantibodies are closely related to the chronic disease of graft kidney， and their predictive value for graft arteritis and chronic graft nephropathy is higher than that for rejection. 

Key words:

 , Renal transplantation； Non-HLA antibodies； Rejection； Graft chronic lesions

摘要：

目的 探讨肾移植术后受者非人类白细胞抗原（human leukocyte antigen，HLA）抗体特征及其与移植肾病理状态的关系。方法 回顾性分析 2016 — 2022 年 444 例肾脏移植术后受者非 HLA 抗体检测资料，根据移植肾病理诊断结果分为排斥反应组（47 例）、非排斥反应组（61 例）、肾功能稳定组（336 例）。应用 GraphPad Prism 9.0 统计软件，分析肾脏移植术后非 HLA 抗体的特征，非 HLA 抗体与 HLA 抗体的相关性，非 HLA 抗体与移植肾病理状态的关系。结果 444 例受者中，非 HLA 抗体阳性为 69.8%（310 例），与 HLA抗体呈正相关关系（r ＝ 0.606，P ＜ 0.001），术后 HLA 抗体阳性受者非 HLA 抗体中位 MFI 值及和阈值的中位倍数高于 HLA 抗体阴性患者。排斥反应组，非排斥反应组及肾功能稳定组之间常见非 HLA 抗体存在差异。非 HLA 抗体与慢性肾小球病变（r ＝ 0.186，P ＝ 0.033），间质纤维化（r ＝ 0.265，P ＝ 0.002）呈正相关关系。受试者工作特征曲线（receiver operating characteristic curve，ROC）分析发现，非 HLA 抗体预测移植肾动脉炎（AUC ＝ 0.771）和慢性肾小球病变（AUC ＝ 0.741）诊断价值较高，但是预测排斥反应的能力不强（AUC ＝ 0.605）。结论 肾移植术后非 HLA 抗体阳性率较高。排斥反应、非排斥反应及移植肾功能稳定受者常见非 HLA 抗体不同。非 HLA 抗体与移植肾慢性病变关系密切，并且对移植肾动脉炎和移植肾慢性病变的预测价值高于对排斥反应的预测价值。 

关键词:

肾脏移植 , 非人类白细胞抗原抗体 , 排斥反应 , 移植肾慢性病变