原著
フローサイトメトリークロスマッチ陰性・既存ドナー特異的抗体陽性腎移植に対するエベロリムス併用導入免疫抑制療法の意義
キーワード:
kidney transplantation,
pre-formed donor-specific antibody,
HLA,
everolimus,
antibody suppression
2025 年 60 巻 3 号 p. 143-148
詳細
2025 年 60 巻 3 号 p. 143-148
【Objective】 Preformed donor-specific anti-HLA antibodies (pDSA) in kidney transplantation (KT) are highly associated with poor graft survival. Conventional immunosuppression induction includes calcineurin inhibitors (CNI), antimetabolites (AM), corticosteroids (CS), and monoclonal antibodies. Additionally, the mTOR inhibitor everolimus (EVR) is expected to provide beneficial effects. We investigated the long-term effects of EVR on KT outcomes in pDSA-positive recipients.
【Materials and Methods】 Forty-two flowcytometry crossmatch-negative, pDSA-positive KT recipients at our hospital from 2005 to 2020 were enrolled. Patients were retrospectively divided into two groups: EVR group (n＝22, 2012-2020) : received EVR in combination with CNI, AM, and CS. MP group (historical control, n＝20, 2008-2012) : received CNI/AM and preoperative/maintenance CS. Both groups received basiliximab and rituximab as induction therapy. Recipients were additionally given plasmapheresis or intravenous immunoglobulin administration before KT. Outcomes analyzed retrospectively included patient survival, graft survival, incidence of antibody-mediated rejection (AMR), and rate of negative conversion of pDSA.
【Results】 Background characteristics were comparable between the groups, except for a significantly shorter follow-up period and a higher median dose of rituximab in the EVR group (9.2 vs. 14.7 years, p＝0.04 and 200 mg vs. 100 mg, p<0.001, respectively). Patient and graft survival at 10 years post-transplant was similar between the two groups. Notably, median time to negative conversion of pDSA tended to be shorter in the EVR group (3.3 years EVR vs. 5.9 MP years, p＝0.08). The higher rituximab dose in the EVR group may have contributed to this outcome. Incidence of AMR was similar in both groups, indicating a possible earlier suppression of pDSA in the EVR group without an increase in the incidence of rejection.
【Conclusion】 Everolimus combined with basiliximab induction tends to promote earlier suppression of pDSA in pDSA-positive kidney transplant recipients.
