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Transfusionsmedizin 2016; 6(04): 165-168
DOI: 10.1055/s-0042-118486
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

sCD30 bei DSA-positiven Nierentransplantatempfängern

sCD30 in DSA-positive Kidney Transplant Recipients
C. Süsal
Transplantationsimmunologie, Institut für Immunologie, Universität Heidelberg, Heidelberg
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Publication History

Publication Date:
15 December 2016 (online)

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Zusammenfassung

Es ist ein ungelöstes Problem, warum bei manchen Nierentransplantatempfängern, die vor der Transplantation donorspezifische HLA-Antikörper (DSA) in ihrem Serum aufweisen, das Risiko des Transplantatverlusts höher ist, während bei anderen Patienten die DSA das Transplantatüberleben überhaupt nicht beeinflussen. In einer vor Kurzem in der Zeitschrift EBioMedicine veröffentlichten Studie untersuchten wir, ob für die schädigende Wirkung von DSA die Hilfe von aktivierten T-Zellen notwendig ist. Die Auswirkung von vor der Transplantation gemessenen DSA und dem T-Zell-Aktivierungsmarker lösliches CD30 (sCD30) auf das 3-Jahres-Transplantatüberleben wurde bei 385 vorsensibilisierten Nierentransplantatempfängern mit HLA-Antikörpern analysiert. Ein schädigender Einfluss von DSA auf das Transplantatüberleben konnte lediglich bei Patienten nachgewiesen werden, die gleichzeitig auch positiv auf den Immunaktivierungsmarker sCD30 getestet wurden. War das Ergebnis der sCD30-Untersuchung negativ, war das Transplantatüberleben bei Patienten mit oder ohne DSA ähnlich. Selbst bei Anwesenheit starker DSA blieb das Transplantatüberleben gut, wenn die Empfänger zum Zeitpunkt der Transplantation sCD30-negativ waren. Bei Patienten, die sowohl sCD30- als auch DSA-positiv waren, wurde hingegen eine sehr niedrige 3-Jahres-Überlebensrate von 62,1 ± 6,4 % beobachtet. Bei diesen Patienten war das Risiko für einen Transplantatverlust in den ersten 3 Jahren fast auf das 3-Fache erhöht (Hazard Ratio 2,92; p < 0,001). Die Studie zeigte, dass die vor der Transplantation im Serum der Patienten vorhandenen DSA in der heute angewandten Immunsuppressions-, Antikörperscreenings- und Crossmatch-Praxis nur dann einen signifikant schädigenden Einfluss auf das Transplantatüberleben haben, wenn gleichzeitig ein präaktivierter Immunstatus vorliegt. Wenn diese Ergebnisse sich bestätigen lassen, könnten DSA-positive, jedoch sCD30-negative Patienten ohne spezielle Maßnahmen transplantiert werden.

Abstract

It is an unresolved issue why some kidney transplant recipients with pretransplant donor-specific HLA antibodies (DSA) show a high transplant failure rate, whereas in other patients DSA do not harm the graft. In a recent study published in EBioMedicine we investigated whether help from preactivated T-cells might be necessary for DSA to exert a deleterious effect. The impact of pretransplant DSA and immune activation marker soluble CD30 (sCD30) on the 3-year graft survival was analyzed in 385 presensitized kidney transplant recipients. A deleterious influence of pretransplant DSA on graft survival could be demonstrated only in patients who were positive for the immune activation marker sCD30. In the absence of sCD30 positivity, graft survival was almost identical in patients with or without DSA, even in patients with strong DSA. A strikingly low 3-year graft survival rate of 62.1 ± 6.4 % was observed in patients who were both sCD30 and DSA positive. The risk of graft loss within the first 3 years after transplantation was almost 3-fold higher in these patients (HR 2.92, p < 0.001). Pretransplant DSA have a significantly deleterious impact on graft survival only in the presence of high pretransplant levels of the activation marker sCD30. Special measures may be unnecessary in DSA-positive recipients with low sCD30.

Schlüsselwörter

Single Antigen Bead - HLA-Antikörper - donorspezifische Antikörper - sCD30 - Nierentransplantation - Transplantatüberleben

Key words

single antigen bead - HLA antibodies - donor-specific antibodies - sCD30 - kidney transplantation - graft outcome
 

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