대한신장학회

논문분류	춘계학술대회 초록집
제목	Clinical impact of HLA-DSA Measured by Luminex Technique in Kidney Transplant Recipients with Renal Allograft Dysfunction
저자	Byung Ha Chung1, Eun-Jee Oh2, Bum Soon Choi1, Cheol Whee Park1,Yeong Jin Choi3, Yong-Soo Kim1, Chul Woo Yang1
출판정보	2014; 2014(1):
키워드	공여자 특이항체, 신장이식, 거부반응
초록	Department of Hospital Pathology3, The Catholic University of Korea Seoul St. Mary In this study, we aimed to investigate the clinical impact of donor-specific anti-HLA-antibody (HLA-DSA) measured using the Luminex single-antigen assay in patients who took indicated biopsy due to allograft dysfunction. Between Feb. 2010 and Feb. 2013, total 210 cases of indication biopsy were performed in St. Mary’s hospital. In all cases, we examined the presence of HLA-DSA using Luminex technique when allograft biopsy was done. Advanced chronic change (IF/TA III-IV), recurrent glomerulonephritis, BK virus nephropathy or diabetic nephropathy were excluded, hence we included 170 cases of biopsy in this analysis. We investigated the pathologic finding of biopsy specimen and the clinical impact of HLA-DSA in those cases. Among 170 cases, antibody mediated rejection (AMR) were 25 cases and 73 cases were diagnosed as T cell mediated rejection (TCMR), and remained 72 cases were calcineurin inhibitor toxicity (n=44), borderline change (n=20) or mild acute tubular necrosis (n=8). HLA-DSA exists at the time of biopsy in 23 cases of AMR (92%). In 73 cases of TCMR, HLA-DSA was detected in 41 cases (56.2%). In contrast, it was rarely detected in other cases without rejection. In TCMR, cases with HLA-DSA showed higher rate of steroid resistance compared to cases without HLA-DSA (41% (14/33) vs. 13.3% (4/30), p<0.05). In addition, allograft function allograft function at 3 and 6 months after allograft biopsy showed more deteriorating pattern in cases with HLA- DSA (p<0.05 respectively). Allograft survival rate after allograft biopsy was significantly inferior in cases with HLA-DSA compared to cases without HLA-DSA as well (p=0.03). In contrast, in cases with AMR, CNI toxicity or borderline change, the presence of HLA-DSA did not affect the allograft outcome after biopsy. HLA-DSA was commonly detected in cases with allograft dysfunction even in TCMR and it is useful to predict the clinical outcome after the diagnosis of TCMR.
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