Renal Transplantation in Relation to Positive T-cell Flow Cytometric Crossmatch: A Retrospective Study

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings Pub Date : 2025-07-01 DOI:10.1016/j.transproceed.2025.05.011

Hisashi Murakami, Yuki Nakamura, Katsuyuki Miki, Takayoshi Yokoyama, Yasuo Ishii

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引用次数: 0

Abstract

Background

Human leukocyte antigen antibodies play a significant role in kidney transplant rejection at all stages. Cross-matching and human leukocyte antigen antibody testing, especially in donor-specific antibody (DSA)-positive cases, are essential for reducing the risk of antibody-mediated rejection. Despite increasing numbers of DSA-positive transplants with desensitization therapy, guidelines for assessing transplant suitability and therapy selection remain undefined. This study retrospectively evaluated 12-month outcomes in patients with kidney transplants and positive flow cytometric crossmatch-T (FCXM-T) results.

Methods

This study analyzed 200 patients who received kidney transplants at Toranomon Hospital Renal Center between January 2015 and January 2022. Of these, 161 living-donor transplants were selected. The patients were divided into FCXM-T-positive and FCXM-T-negative groups. Regardless of ABO incompatibility, antithymocyte globulin, and rituximab or intravenous immunoglobulin were administered in FCXM-T-positive and DSA-positive cases, whereas rituximab or intravenous immunoglobulin was administered in FCXM-T-positive and DSA-negative cases. Serum creatinine and proteinuria levels were compared 12 months postoperatively using overlap weighting to balance the background factors. FCXM-T-positive cases were further assessed for new DSA development and desensitization effects.

Results

After overlap weighting, creatinine levels (1.33 mg/dL vs 1.38 mg/dL, P = .17) and proteinuria positivity (24% vs 30%, P = .93) did not differ between the FCXM-T-positive and FCXM-T-negative groups at 12 months. The appearance of new DSA was also similar between the groups, suggesting comparable short-term outcomes with appropriate desensitization therapy.

Conclusions

Preoperative desensitization, including antithymocyte globulin, may enable safe kidney transplantation in FCXM-T-positive patients, yielding outcomes comparable to those of low-risk patients. Further long-term studies are required to confirm these findings.

查看原文本刊更多论文

肾移植与t细胞流式细胞交叉配型阳性的关系：一项回顾性研究。

背景：人白细胞抗原抗体在肾移植各阶段排斥反应中起重要作用。交叉配型和人白细胞抗原抗体检测，特别是在供体特异性抗体（DSA）阳性病例中，对于降低抗体介导的排斥反应的风险至关重要。尽管越来越多的dsa阳性移植采用脱敏治疗，但评估移植适用性和治疗选择的指南仍不明确。本研究回顾性评估了肾移植患者12个月的结果和流式细胞交叉匹配t （FCXM-T）阳性结果。方法：本研究分析了2015年1月至2022年1月在Toranomon医院肾脏中心接受肾脏移植的200例患者。其中，161例活体供体移植被选中。患者分为fcxm - t阳性组和fcxm - t阴性组。无论ABO血型不合，fcxm - t阳性和dsa阳性病例均给予抗胸腺细胞球蛋白和利妥昔单抗或静脉注射免疫球蛋白，而fcxm - t阳性和dsa阴性病例则给予利妥昔单抗或静脉注射免疫球蛋白。术后12个月比较血清肌酐和蛋白尿水平，采用重叠加权法平衡背景因素。fcxm - t阳性病例进一步评估新的DSA发展和脱敏效果。结果：重叠加权后，12个月时fcxm - t阳性组和fcxm - t阴性组的肌酐水平（1.33 mg/dL vs 1.38 mg/dL, P = 0.17）和蛋白尿阳性（24% vs 30%, P = 0.93）无差异。两组之间新的DSA的出现也相似，表明适当脱敏治疗的短期结果相似。结论：术前脱敏，包括抗胸腺细胞球蛋白，可能使fcxm - t阳性患者的肾移植安全，其结果与低风险患者相当。需要进一步的长期研究来证实这些发现。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplantation proceedings 医学-免疫学

CiteScore

1.70

自引率

0.00%

发文量

502

审稿时长

60 days

期刊介绍： Transplantation Proceedings publishes several different categories of manuscripts, all of which undergo extensive peer review by recognized authorities in the field prior to their acceptance for publication. The first type of manuscripts consists of sets of papers providing an in-depth expression of the current state of the art in various rapidly developing components of world transplantation biology and medicine. These manuscripts emanate from congresses of the affiliated transplantation societies, from Symposia sponsored by the Societies, as well as special Conferences and Workshops covering related topics. Transplantation Proceedings also publishes several special sections including publication of Clinical Transplantation Proceedings, being rapid original contributions of preclinical and clinical experiences. These manuscripts undergo review by members of the Editorial Board. Original basic or clinical science articles, clinical trials and case studies can be submitted to the journal?s open access companion title Transplantation Reports.