Focal peritubular capillary C4d deposition in acute rejection
Focal peritubular capillary C4d deposition in acute rejection
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DOI：
10.1093/ndt/gfk028
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发表时间：
2006-05-01
影响因子：
6.1
通讯作者：
Tinckam, KJ
中科院分区：
文献类型：
--
作者：
Magil, AB;Tinckam, KJ
背景。弥漫性小管周围毛细血管（PTC） C4d沉积与相对较差的移植物预后有关。移植后早期局灶性PTC C4d染色的意义尚不明确。对53例急性排斥患者的65例活检进行分级（Banff '97标准），对C4d、单核细胞和T细胞进行染色，并根据PTC C4d分为三组：(i)局灶性C4d (F)（14例活检，14例），（ii）弥漫性C4d (D)（23例活检，15例）和（iii）无C4d (N)（28例活检，24例）。比较三组的各种活检和临床参数，包括结果。移植肾炎和肾小球单核细胞浸润的发生率F组（64%,2.0 +/- 2.0）和D组（57%,3.4 +/- 2.0）明显高于N组（11%,0.2 +/- 0.2）。F组出现急性细胞排斥反应的比例（93%）明显高于D组（35%）（Banff '97分级>= 1A）。F组和D组的雌性数量（分别为50%和67%）明显多于N组（21%）。F组（29%）和D组（40%）患者接受第二次或第三次移植的比例高于N组（8%）（P = 0.0589）。D组和F组患者在12、24、48个月肾小球滤过率< 30 ml/min的比例高于N组，且3组患者在48个月出现该结果的几率呈统计学显著升高趋势（D > F > N组）（P = 0.0416）。结果提示局灶性PTC C4d染色患者的活检结果和临床病程与弥漫性C4d患者相似。
Background. Diffuse peritubular capillary (PTC) C4d deposition has been shown to be associated with relatively poor graft outcome. The significance of focal PTC C4d staining in the early post-transplant period is uncertain.Methods. Sixty-five biopsies from 53 patients with acute rejection were graded (Banff '97 criteria), stained for C4d, monocytes and T cells, and divided into three groups according to PTC C4d: (i) focal C4d (F) (14 biopsies, 14 patients), (ii) diffuse C4d (D) (23 biopsies, 15 patients) and (iii) no C4d (N) (28 biopsies, 24 patients). The three groups were compared with respect to a variety of biopsy and clinical parameters including outcome.Results. The incidence of transplant glomerulitis and glomerular monocyte infiltration were significantly greater in F (64% and 2.0 +/- 2.0) and D (57% and 3.4 +/- 2.0) than in N (11% and 0.2 +/- 0.2). A significantly higher proportion of F (93%) demonstrated acute cellular rejection (Banff '97 grade >= 1A) than did D (35%). The F and D groups included significantly more females (50 and 67%, respectively) than did N (21%). The percentage of patients with a second or third transplant was higher in F (29%) and D (40%) than in N (8%) (P = 0.0589). The proportion of patients with glomerular filtration rate < 30 ml/min at 12, 24 and 48 months was higher in the D and F groups than in the N, and there was a statistically significant increasing trend in odds of this outcome occurring at 48 months across the three groups (D > F > N group) (P = 0.0416).Conclusion. The results suggest that the biopsy findings and clinical course in patients with focal PTC C4d staining are similar to those associated with diffuse C4d.