| Part Ⅰ:Preliminary Study of HLA Antigens Directed Against by Denovo DSA and Correlation Factors of Dn DQ DSA Generation after Kidney TransplantationObjective To analyze the production regularity of denovo donor specific antibody(dn DSA)in the kidney transplant recipients of our country and correlation factors of denovo HLA-DQ donor specific antibody(dn DQ DSA).Method A retrospective analysis was performed in kidney transplant patients in Shanghai Changhai Hospital from January 2016 to January 2020.The generation rule of DN DSA was analyzed by cross-sectional study,and the correlation factors of dn DQ DSA were analyzed by case-control study.Results A total of 470 kidney transplant patients were included in this study,and 36 patients produced dn DSA,with an incidence of 36/470(7.36%).The difference between each HLA antigens directed against by dn DSA was statistically significant(P < 0.001),among which the number of DQ antigen was 19,the highest(52.8%),and the strong positive proportion(P < 0.001).Through a case-control study,the number of HLA-DQ mismatches was found to be a correlation factor for the generation of dn DQ DSA(P=0.003).Conclusion DN DQ DSA is the main component of dn DSA produced by kidney transplant recipients in China.DQ locus should be included in kidney matching algorithm of COTRS system to reduce the incidence of dn DQ DSA and improve the prognosis of patients.Part Ⅱ: Single Center Clinical Curative Effect Observation of Individualized Treatment for Lowering DSA after Renal TransplantationObjective: To summarize the reducing DSA MFI regimen in our center and observe the treatment effect,so as to provide reference for further optimization of treatment plan.Methods: This study investigated and analyzed the clinical data,DSA changes and renal graft function changes before and after treatment of 34 patients who received rituximab(RTX)+intravenous immunoglobulin(IVIG)based combined therapy in our center from January 1,2016 to January 1,2021,and analyzed the changes of DSA before and after treatment by retrospective observation study.Results:16 patients,DSA turned completely negative after lowering DSA treatment in our center,with a negative conversion rate of 47.06%.Among all HLA sites targeted by DSA,after 3 months of lowering DSA treatment,the negative conversion rate of the DSA that targeted HLA I was 82.61%,and that targeted HLA II was 47.27%,with statistically significant differences(P=0.003).Among sites targeted by dn DSA,the negative conversion rate of DSA that targeted HLA I was 100%,and that targeted HLA II was16.67%,with significant difference(P=0.008).Statistical analysis of immunodominant DSA(i DSA)changes before and after treatment showed that i DSA median fluorescence intensity(MFI)decreased by 66.67% on average at 3 months after treatment and 73.66%at the last follow-up compared with that before treatment,with no statistical significance(t=-1.441,P=0.159).It indicated that there was no significant rebound in DSA MFI of the patients who received the lowering DSA treatment of our center.The renal graft function of patients with pathologically diagnosed AMR in the sample was statistically analyzed and found that grafted renal function decreased significantly before treatment and increased significantly after 3 months of treatment in the average value of e GFR and at the time of the last follow-up no obvious difference was found when compared with 3 months after treatment,the function of the transplanted kidney remained stable overall..Conclusion: The negative conversion rate of DSA targeting HLA I after treatment was significantly higher than that of DSA targeting HLA II.In general,the DSA MFI of patients under the reduced DSA treatment plan in our center did not rebound significantly.After the treatment,the renal transplant function of patients recovered to a certain extent.The patient’s overall graft function remained stable. |
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