Casillas-Abundis A, Alberú J, Morales-Buenrostro LE, Llorente L, Lima G, Arvizu A, De Santiago A, Vilatobá M, Granados J, Cruz R, Contreras AG, Arreola-Guerra JM

Idioma: Ingles.
Referencias bibliográficas: 33
Paginas: 109-119
Archivo PDF: 398.26 Kb.

RESUMEN

Introducción: Los anticuerpos anti-HLA son la principal barrera inmunológica para el trasplante renal. Ya sea preformados y/o desarrollados de novo postrasplante, son los precursores del rechazo humoral, el cual es la principal causa de pérdida del injerto. La caracterización de dichos anticuerpos (Acs) ha delineado un perfil de riesgo asociado con rechazo y pérdida del injerto, siendo la intensidad media de fluorescencia (MFI, por sus siglas en inglés), las especificidades antigénicas HLA, las subclases de IgG y la capacidad de fijación del complemento algunas de las más exploradas. El objetivo del presente estudio es la caracterización de los Acs anti-HLA en la etapa pretrasplante y los factores sensibilizantes asociados (trasplante renal previo, embarazo y transfusiones). Material y métodos: Estudio transversal, observacional y descriptivo de suero de pacientes sensibilizados, potenciales receptores de trasplante. Los sueros fueron evaluados con: determinación de Acs anti-HLA con perlas de antígeno único (SAB, por sus siglas en inglés) (Luminex), subclase de inmunoglobulinas de los Acs y capacidad de fijación de complemento de los mismos mediante C3d. Resultados: Se estudiaron 89 sueros/89 pacientes, con edad promedio de 33.3 años (± 13.8) y 60.2% hombres (n = 54). El 20.4% tenían historia de trasplante previo (n = 18), 17.2% embarazo (n = 15) y 60.2% transfusiones (n = 54). Fueron detectados 1,771 anticuerpos anti-HLA, 367 (20.1%) con alguna subclase de IgG y 216 (12.1%) con fijación de complemento (C3d+). Los factores relacionados a la detección de subclase de IgG fueron: SAB MFI › 4,000 (OR 15.9, 95% IC 11.2-22.4, p = ‹ 0.01), positividad para C3d (OR 3.4, 95% IC 2.4-4.9, p ‹ 0.01) y Acs HLA-B (OR 2.3, 95% IC 1.7-3.2, p ‹ 0.01). Los factores asociados con positividad para C3d: SAB MFI (OR 1.15, 95% IC 1.10-1.21, p ‹ 0.01), Acs HLA-DQ (OR 4.37, 95% IC 2.21-8.66, p ‹ 0.01), Acs HLA-DR (OR 10.24, 95% IC 5.07-20.65, p ‹ 0.01), Acs HLA-B (OR 0.35, 95% IC 0.18-0.67, p ‹ 0.01), detección de subclase de IgG (OR 15.8, 95% IC 7.79-32.2, p ‹ 0.01). Los pacientes con historia de trasplante previo presentaron una mayor cantidad de anticuerpos anti-HLA, mayor MFI, en todos se detectaron subclases de IgG y una mayor cantidad de anticuerpos fijadores de complemento. La subclase de IgG más prevalente fue IgG1 (n = 351, 95.6%). Conclusiones: En general, la detección de subclases de IgG y la capacidad de fijación de complemento C3d de los Acs anti-HLA fue poco frecuente. Sin embargo, en todos los pacientes con antecedente de trasplante previo se identificaron subclases de IgG y en el 90% positividad para C3d. La presencia de subclases de IgG y C3d se relacionó con la MFI de los Acs anti-HLA, significativamente más elevados en pacientes con trasplante previo.

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