Histologic findings of antibody-mediated rejection in ABO blood-group-incompatible living-donor kidney transplantation
Histologic findings of antibody-mediated rejection in ABO blood-group-incompatible living-donor kidney transplantation
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DOI：
10.1046/j.1600-6135.2003.00278.x
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发表时间：
2004-01-01
影响因子：
8.8
通讯作者：
Stegall, MD
中科院分区：
文献类型：
--
作者：
Fidler, ME;Gloor, JM;Stegall, MD
本研究的目的是描述ABO血型不相容（ABOI）肾移植中抗体介导的排斥反应（AMR）的组织学特征，以及在同种异体移植功能稳定时进行的方案活检。在1999年5月至2002年1月间，我们进行了32例ABOI肾移植手术（13例A2血型，19例非A2血型活体供者）。19例进行同种异体移植物功能障碍活检，127例在移植后0、3、7、14、28天、3和12个月进行方案活检。32例患者中有25例移植同种异体具有功能（移植后平均585天）。32例中有9例（28%）发生了临床抗菌素耐药性。活检显示肾小球血栓（78%）、脉管溶解（78%）、小管周围毛细血管C4d染色（56%）、中性粒细胞浸润（67%）、间质出血和坏死（56%）、小动脉血栓（33%）。4例患者的亚临床AMR通过方案活检诊断。结果包括肾小球血栓（100%）、脉管溶解（25%）和C4d染色（100%）。在移植后214420天进行的晚期方案活检中，2/ 17（11.7%）发现轻度系膜松解，3/ 12（25%）检测到C4d免疫染色。AMR表现为肾小球血栓、系膜溶解、小管周围毛细血管中性粒细胞浸润、间质出血、坏死和C4d沉积。肾小球血栓出现在AMR早期，可能出现在移植物功能障碍之前。
The purpose of this study was to characterize the histology of antibody- mediated rejection (AMR) in ABO blood- group- incompatible (ABOI) kidney transplants as well as on protocol biopsies performed at the time of stable allograft function. Between 5/ 99 and 1/ 02, we performed 32 ABOI kidney transplants (13 A2, 19 non- A2 blood- group living donors). Nineteen biopsies were performed for allograft dysfunction, and 127 protocol biopsies were performed 0, 3, 7, 14, 28 days and 3 and 12 months post transplant. Twenty- five of 32 patients have functioning allografts (mean 585 days post transplant). Nine of 32 (28%) developed clinical AMR. Biopsy revealed glomerular thrombi (78%), mesangiolysis (78%), peritubular capillary C4d staining (56%) and neutrophil infiltration (67%), interstitial hemorrhage and necrosis (56%) and arteriolar thrombi (33%). Subclinical AMR was diagnosed by protocol biopsies in four patients. Findings consisted of glomerular thrombi (100%), mesangiolysis (25%), and C4d staining (100%). In late protocol biopsies performed 214420 days post transplant, mild mesangiolysis was seen in 2/ 17 (11.7%), and C4d immunostaining was detected in 3/ 12 (25%). AMR is characterized by glomerular thrombi, mesangiolysis, peritubular capillary neutrophil infiltration interstitial hemorrhage, necrosis, and C4d deposition. Glomerular thrombi appear early in AMR and may appear prior to graft dysfunction.