Die durchflusszytometrische Verträglichkeitsprobe – sensitivere Diagnostik zur Prädiktion von Transplantatabstoßungen

Zusammenfassung

Bei der Lebendnierenspende hat man die Chance, das immunologische Risiko vor Transplantation sehr detailliert zu testen. Neben der Bestimmung der humanen Leukozytenantigene (HLA) ist die Suche nach HLA-Antikörpern und die Verträglichkeitsprobe (Crossmatch) zwingend erforderlich, wobei in Deutschland derzeit als Standard die komplementvermittelte Zytotoxizität gemessen wird (CDC-Crossmatch). Es geht darum, herauszufinden, ob der Empfänger präformierte spenderspezifische Antikörper hat, die eine Transplantatabstoßung auslösen können. Im Ausland, beispielsweise in Großbritannien, ist dagegen das durchflusszytometrische Crossmatch inzwischen als Standardverfahren etabliert. Dieses wurde bereits 1983 beschrieben und ist sensitiver als das CDC-Crossmatch. Es gibt inzwischen umfangreiche Studien, die zeigen, dass ein positives durchflusszytometrisches Crossmatch ein erhöhtes Risiko für antikörpervermittelte Abstoßungen anzeigt. Dies konnte in unserer Kohorte bestätigt werden, in der ein positives durchflusszytometrisches Crossmatch für die T-Zellen ein 10,1-fach und für die B-Zellen ein 3,2-fach erhöhtes Risiko anzeigt.

Abstract

Prior to living kidney donation the immunological risk can be assessed very detailed. Apart from testing for human leukocyte antigens (HLA) the detection of HLA antibodies and the crossmatch are mandatory. In Germany, the standard method is still based on complement dependent cytotoxicity (CDC crossmatch). It is used to detect preformed donor-specific antibodies that could lead to transplant rejection. Abroad, for example in Great Britain, the flow cytometric crossmatch is currently established as a standard assay. This crossmatch was already described in 1983 and it is more sensitive than the CDC crossmatch. There are comprehensive data showing that a positive flow cytometric crossmatch indicates an increased risk of antibody mediated rejection. We could confirm these data in our own cohort; a positive T cell flow crossmatch indicated a 10.1-fold and a positive B cell crossmatch a 3.2-fold increased risk.

Schlüsselwörter

durchflusszytometrisches Crossmatch - Crossmatch zur Detektion von komplementvermittelter Zytotoxizität - antikörpervermittelte Abstoßung - Lebendnierenspende

Key words

flow cytometric crossmatch - CDC crossmatch - antibody mediated rejection - living kidney donation

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