Association between immunological high-responder and rejection in organ transplantation

2022 Fiscal Year Final Research Report

• Project/Area Number: 20K08949
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Review Section: Basic Section 55010:General surgery and pediatric surgery-related
• Research Institution: Akita University
• Principal Investigator: Saito Mitsuru 秋田大学, 医学部附属病院, 准教授 (80400505)
• Project Period (FY): 2020-04-01 – 2023-03-31
• Keywords: 抗HLA抗体 / CREG / de novo DSA / 皮膚移植 / マウス / 輸血

Outline of Final Research Achievements

Little is known about the impact of posttransplant blood transfusion (BT) on the sensitization of anti-HLA antibodies and the formation of dnDSAs. Consecutive 241 patients who underwent KTx at Akita University Hospital were enrolled in this study. Of these, 61.4% received BT. There were significantly more women, preemptive cases, and immunologically high-risk cases in the transfusion group than those in the nontransfusion group. The Hb level of patients in the transfusion group immediately before KTx was significantly lower compared with that of patients in the nontransfusion group. In this study, Hb < 11 g/dL immediately before KTx, blood loss > 300 mL at KTx, preemptive cases, female, were independent risk factors for transfusion therapy. Incidence of dnDSA in the transfusion group tended to be more than the nontransfusion group, and graft survival in the transfusion group tended to be worse than the nontransfusion group. BT may be an independent risk factor for dnDSA formation.

Free Research Field

腎移植、移植免疫

Academic Significance and Societal Importance of the Research Achievements

近年、腎代替療法を受ける患者の高齢化、そして移植成績向上に伴うHLAミスマッチの多い夫婦間移植が増加している。高齢者への強力な免疫抑制療法はときに重篤な感染症を引き起こすことがあり、CREG保有例などにおいて正確な免疫学的リスク判定が必要である。
また、生体腎移植は基本的に最善の状態に合わせて手術を行うことが出来る。腎移植待機者が腎性貧血ガイドラインに記載されている様な適切な貧血管理がなされていれば輸血を行う頻度が少なくなるため、周術期輸血⇒de novo DSA↑⇒移植腎予後悪化、という悪循環に陥らなくなる。腎移植レシピエントの長期成績の向上は社会的にもインパクトが大きいと考える。