CAJ | 학술논문

目的探讨术前C1q结合的供者特异性抗体(C1q+ DSA)预测高致敏肾移植受者术后早期抗体介导排斥反应(AMR)的价值.方法回顾性分析2012年1月至2014年1月30例术前存在高致敏状态的肾移植受者的临床资料,采用单抗原磁珠法检测受者术前的供者特异性抗体(DSA)和C1q+ DSA,并分析术前DSA和C1q+ DSA与术后早期AMR的关系.结果术前DSA阳性者22例,其中12例为C1q+ DSA,10例发生AMR(包括3例超急性排斥反应).术前DSA预测术后发生AMR的敏感性100％,特异性为40％,阳性预测值为45.5％,阴性预测值为100％;C1q+ DSA预测AMR的敏感性为100％,特异性为90％,阳性预测值为83.3％,阴性预测值100％.与DSA预测AMR相比,C1q+ DSA的特异性和阳性预测值均显著升高(P＜0.01,P＜0.05).结论 C1q+ DSA可以预测术后早期AMR的发生,术前区分补体结合的DSA和非补体结合的DSA,避开C1q阳性的抗HLA抗体能增加高致敏患者的移植机会,减少AMR的发生风险.
목적 탐토술전C1q결합적공자특이성항체(C1q+ DSA)예측고치민신이식수자술후조기항체개도배척반응(AMR)적개치.방법 회고성분석2012년1월지2014년1월30례술전존재고치민상태적신이식수자적림상자료,채용단항원자주법검측수자술전적공자특이성항체(DSA)화C1q+ DSA,병분석술전DSA화C1q+ DSA여술후조기AMR적관계.결과 술전DSA양성자22례,기중12례위C1q+ DSA,10례발생AMR(포괄3례초급성배척반응).술전DSA예측술후발생AMR적민감성100％,특이성위40％,양성예측치위45.5％,음성예측치위100％;C1q+ DSA예측AMR적민감성위100％,특이성위90％,양성예측치위83.3％,음성예측치100％.여DSA예측AMR상비,C1q+ DSA적특이성화양성예측치균현저승고(P＜0.01,P＜0.05).결론 C1q+ DSA가이예측술후조기AMR적발생,술전구분보체결합적DSA화비보체결합적DSA,피개C1q양성적항HLA항체능증가고치민환자적이식궤회,감소AMR적발생풍험.
Objective To investigate the C1q fixing donor specific antibody (C1q+ DSA) predicting antibody-mediated rejection (AMR) early after transplantation in sensitized renal transplantation patients.Method DSA and C1q+ DSA were retrospectively analyzed in 30 highly sensitized renal transplant patients using a Luminex platform from Jan.2012 to Jan.2014 in our hospital.The relationship between preoperative C1q+ DSA and AMR early after transplantation was analyzed.Result DSA was detected in 20 cases before operation,C1q+ DSA in 12 cases,and AMR in 10 cases (including 3 cases of hyperacute rejection).Preoperative C1q+ DSA had a positive predictive value (PPV) of 83.3％ and a negative predictive value (NPV) of 100％,with 100％ sensitivity and 90％ specificity for AMR respectively.C1q+ DSA had higher positive predictive value (83.3％ vs.45.5％,P＜0.05) and higher specificity (90％ vs.40％,P＜0.01) than DSA for AMR.Conclusion The C1q assay can detect a sub-set of antibodies capable of fixing complement and predict AMR early after transplantation.Avoiding only the donor antigens that would be recognized by the C1q assay may accelerate time to transplantation by expansion of the donor pool and reduce AMR.