nidНефрология и диализNephrology and Dialysis1680-44222618-9801Российское диализное обществоnid-524Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESДиагностическое значение антител к HLA при хроническом и позднем остром отторжении трансплантата почкиDiagnostic value of anti-hla antibodies at chronic and late acute rejection of kidney transplantИвановаЕ. С.IvanovaE. S.katerineiv@mail.ruСтоляревичЕ. С.StolyarevichE. S.noemail@neicon.ruБарановаФ. С.BaranovaF. S.noemail@neicon.ruАртюхинаЛ. Ю.ArtyukhinaL. Y.noemail@neicon.ruГичкунО. Е.GichkunY. E.noemail@neicon.ruБогдановаН. Б.BogdanovaN. B.noemail@neicon.ruТомилинаН. А.TomilinaN. A.noemail@neicon.ruГБУЗ «Городская клиническая больница №52 Департамента здравоохранения г. Москвы»; Московский городской нефрологический центрРоссияMoscow City Nephrology Center; Moscow City Hospital 52Russian FederationГБУЗ «Городская клиническая больница №52 Департамента здравоохранения г. Москвы»; Московский городской нефрологический центр; ФБГУ «ФНЦ Трансплантологии и искусственных органов им. академика В.И. Шумакова» Министерства здравоохранения Российской Федерации; ФПДО ФГБУ ФГОУ «Московский государственный медико-стоматологический университет им. А.И. Евдокимова»РоссияMoscow City Nephrology Center; Moscow City Hospital 52; Academician V.I. Shumakov Federal Research Center of Transplantology and Artificial Organs; A.I. Evdokimov Moscow State University of Medicine and DentistryRussian FederationФБГУ «ФНЦ Трансплантологии и искусственных органов им. академика В.И. Шумакова» Министерства здравоохранения Российской ФедерацииРоссияAcademician V.I. Shumakov Federal Research Center of Transplantology and Artificial OrgansRussian Federation201529082024174437444Copyright © Иванова Е.С., Столяревич Е.С., Баранова Ф.С., Артюхина Л.Ю., Гичкун О.Е., Богданова Н.Б., Томилина Н.А., 20242024Иванова Е.С., Столяревич Е.С., Баранова Ф.С., Артюхина Л.Ю., Гичкун О.Е., Богданова Н.Б., Томилина Н.А.Ivanova E.S., Stolyarevich E.S., Baranova F.S., Artyukhina L.Y., Gichkun Y.E., Bogdanova N.B., Tomilina N.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephro.ru/jour/article/view/524

Цель исследования: анализ корреляций между выявлением АТ к HLA I и II классов, свечением С4d и выявлением микроциркуляторного воспаления при позднем остром и хроническом отторжении трансплантата. Материалы и методы. В исследование включены 108 пациентов с дисфункцией почечного трансплантата, которым была выполнена биопсия трансплантата (c определением С4d) и исследованы АТ к HLA. На основании морфологического диагноза пациенты были разделены на 3 группы: 1 группа (n=50) - пациенты с хроническим отторжением трансплантата (ХОТ), 2 группа (n=24) пациенты с кризами отторжения трансплантата с признаками микроциркуляторного воспаления (криз с м/в), 3 группа (n=34) - пациенты с иной патологией трансплантата (группа контроля). Результаты. АТ к HLA определялись у 70% пациентов 1 группы, 62% пациентов 2 группы и у 29% в 3 (контрольной) группе. При этом титр антител был значимо выше в С4d+ случаях, независимо от характера свечения. У 48% и 57% пациентов в 1 и 2 группах выявлялись оба маркера гуморального отторжения (С4d и АТ к HLA), что позволяло верифицировать диагноз без дальнейшего уточнения характера антител. В случаях выявления изолированного свечения С4d (12% и 35% в 1 и 2 группах) потребовалось использование более чувствительной методики определения антител (LUMINEX). Присутствие АТ к HLA в отсутствие свечения С4d, выявлявшееся у 22% пациентов 1 группы и у 29% в группе контроля, требовало определения донор-специфичности выявленных антител. Заключение. Скрининговое определение АТ к HLA является первым этапом выявления донор-специфических антител, однако в некоторых случаях при наличии данных биопсии трансплантата также может применяться как независимый метод диагностики.

Aim: to analyze the correlations between class-I and class-II anti-HLA antibodies with microvascular inflammation and C4d-staining in cases of late acute and chronic graft rejection. Materials and methods: The study included 108 patients with indicative graft biopsies (with C4d-staining) and detection of anti-HLA antibodies (ELISA). Patients were divided into 3 groups based on pathology pattern: group 1 (n=50) consisted of patients with chronic graft rejection, group 2 included 24 patients with acute graft rejection with microvascular inflammation, group 3 (n=34) was presented by patients with other graft pathology (control group). Results: Anti-HLA antibodies (predominantly class-II anti-HLA) were identified in 70% of patients of group 1, in 62% of patients of group 2 and 29% patients of group 3 (control). The level of class-II anti-HLA antibodies was significantly higher in C4d-positive cases with no difference between its focal or diffuse expression. In 48% and 57% of patients of 1 and 2 groups, respectively both C4d and anti-HLA antibodies were positive and we considered these cases as AMR without subsequent DSA detection. In cases of isolated C4d staining (12% and 35% of cases in 1 and 2 group, respectively) more sensitive methods (LUMINEX) were needed. In C4d-negative cases (22% in group 1 and 29% in control group) single antigen detection of DSA should be performed. Conclusion: Screening of anti-HLA antibody is a first step of DSA detection, but it can be used as an independent method of diagnosis in the presence of biopsy data in some cases.

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The authors declare that there are no conflicts of interest present.