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.

摘要：

目的 探讨致敏患者肾移植术前应用单抗原磁珠法检测到的供者特异性抗体（donor specific antibody， DSA）的平均荧光强度（mean fluorescence intensity， MFI）及类别与术后早期抗体介导排 斥反应（antibody mediated rejection， AMR）的关系。方法 回顾性分析 2012 年 1 月 - 2014 年 1 月天津市 第一中心医院 30 例术前致敏的肾移植患者资料，采用单抗原磁珠法检测术前 DSA，分析术前预存的 DSA 抗体类别及荧光强度与术后早期 AMR 的关系。结果 术前预存 DSA 患者 22 例，单纯Ⅰ类阳性患者 9 例， 单纯Ⅱ类阳性 7 例，Ⅰ、Ⅱ类均阳性 6 例，其中 10 例（45.5%）发生 AMR。比较 AMR 阳性组和 AMR 阴 性组两组间Ⅰ类 DSA MFI 值，Ⅰ类强阳性 DSA（MFI ≥ 8 000）差异有统计学意义（P ＜ 0.05），而两组 间群体反应性抗体（panel reactive antibody， PRA）水平、Ⅱ类 DSA MFI 值差异均无统计学意义（均 P ＞ 0.05）。术前Ⅰ类强阳性 DSA 的 7 例患者中有 6 例（占 85.7%）发生 AMR，而术前Ⅰ类 DSA 轻、中度阳性 （1 000 ＜ MFI ＜ 8 000）的 8 例患者中有 2 例（占 25%）发生 AMR，两者差异有统计学意义（P ＜ 0.05）。 术前Ⅰ类强阳性 DSA 预测 AMR 的敏感度为 75%，特异度为 85.7%，阳性预测值为 85.7%，阴性预测值 为 75%。结论 术前避开强阳性的Ⅰ类 DSA 能增加致敏患者肾移植的机会，减少术后早期 AMR 的发生。 术前对预存供者特异性抗体分层分析能增加致敏患者肾移植的机会。