血液细胞抗原的异基因免疫不良反应与肝移植受体存活率降低无关

Alloimmunization Against RBC Antigens Is Not Associated With Decreased Survival in Liver Transplant Recipients

AMERICAN JOURNAL OF CLINICAL PATHOLOGY

影响因子:1.9

分区:医学4区 / 病理学3区

发表日期:2023 Mar 13

作者: Yevgen Chornenkyy, Alcino Pires Gama, Christopher Felicelli, Nigar Khurram, Adam L Booth, Joseph R Leventhal, Glenn Eugene Ramsey, Guang-Yu Yang

DOI: 10.1093/ajcp/aqac150

摘要

改善肝移植（LT）预后需要更好地理解影响存活率的因素。评估了血液细胞抗原（RBC）异基因抗体（RBCAs）对LT受体存活的影响。本研究为单中心、回顾性队列研究，回顾了2002年至2021年的输血记录和全因死亡情况。2002年至2021年期间，共完成了2079例肝移植，其中符合纳入标准的为1396例（RBC反应阴性1305例；RBC反应阳性91例[6.5%]）。两组在年龄（平均[范围]，55.8[17-79]岁vs 56.8[25-73]岁；P = .41）或性别（RBC反应阴性，859例[65%]男性和446例[35%]女性；RBC反应阳性，51例[56%]男性和40例[44%]女性；P = .0684）方面类似。在检测到的132例RBCAs中，最常见的10种抗体为E（27.27%）、Jka（15.91%）、K（9.09%）、C（8.33%）、M（6.06%）、D（5.3%）、Fya（4.55%）、e（2.27%）、c（2.27%）和Jkb（2.27%）。27例患者（29.7%）具有多于1种RBCA；最常见的组合为C与Jka（7.4%）以及E与Dia（7.4%）。全因死亡率在男性中增加（男性，14.45年vs女性，17.27年；P = .0266），以及在65岁及以上患者中（≥65岁，10.21年vs<64岁，17.22年；P < .0001）。存在RBCA（≥1）并不影响全因死亡率（RBCA阴性，14.17年vs RBCA阳性，15.29年；P = .4367）。最常见的死因包括感染（11.9%）、原发性恶性肿瘤（实体瘤）（10.8%）、复发性恶性肿瘤（10.5%）、心血管骤停（7.1%）以及肺功能不全/呼吸衰竭（5.7%）。RBCA阳性肝移植受体的存活率与RBCA阴性受体无差异。

Abstract

Improvement of liver transplantation (LT) outcomes requires better understanding of factors affecting survival. The presence of RBC alloantibodies (RBCAs) on survival in LT recipients was evaluated.This study was a single-center, retrospective cohort study reviewing transfusion records and all-cause mortality between 2002 and 2021.Between 2002 and 2021, 2079 LTs were completed, 1,396 of which met inclusion criteria (1,305 RBCA negative; 91 RBCA positive [6.5%]). The cohorts were similar in age (mean [range], 55.8 [17-79] years vs 56.8 [25-73] years; P = .41, respectively) or sex (RBCA negative, 859 [65%] men and 446 [35%] women vs RBCA positive, 51 [56%] men and 40 [44%] women; P = .0684). Of 132 RBCAs detected, 10 were most common were to E (27.27%), Jka (15.91%), K (9.09%), C (8.33%), M (6.06%), D (5.3%), Fya (4.55%), e (2.27%), c (2.27%), and Jkb (2.27%). Twenty-seven patients (29.7%) had more than 1 RBCA; the most common combinations were C with Jka (7.4%) and E with Dia (7.4%). All-cause mortality was increased in men (men, 14.45 years vs women, 17.27 years; P = .0266) and patients 65 years of age and older (≥65 years of age, 10.21 years vs <64 years of age, 17.22 years; P < .0001). The presence of RBCA (≥1) did not affect all-cause mortality (RBCA negative, 14.17 years vs RBCA positive, 15.29 years; P = .4367). The top 5 causes of death were infection (11.9%), primary malignancy (solid) (10.8%), recurrent malignancy (10.5%), cardiovascular arrest (7.1%), and pulmonary insufficiency/respiratory failure (5.7%).Survival in RBCA-positive LT recipients is no different from that in RBCA-negative LT recipients.