Proliferative glomerulonephritis with monoclonal immunoglobulin G deposits is associated with high rate of early recurrence in the allograft
Proliferative glomerulonephritis with monoclonal immunoglobulin G deposits is associated with high rate of early recurrence in the allograft
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DOI：
10.1016/j.kint.2018.01.028
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发表时间：
2018-07-01
影响因子：
19.6
通讯作者：
Nasr, Samih H.
中科院分区：
文献类型：
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作者：
Said, Samar M.;Cosio, Fernando G.;Nasr, Samih H.
伴有单抗免疫球蛋白G沉积的同种异体移植物增生性肾小球肾炎(PGNMID)的特征尚不清楚。为了更好地确定这种疾病的特征，我们回顾了26例同种异体移植的PGNMID患者，其中16例随后进行了早期方案活组织检查。在大多数(89%)患者中，PGNMID是一种复发性疾病。在大多数患者中，对蛋白尿和/或肌酐升高进行了诊断性活检。从移植到诊断性活检的中位时间为5.5个月，86%的患者在移植后三到四个月内检测到。系膜增生性肾小球肾炎是诊断活检中最常见的类型，89%的病例显示免疫球蛋白G3亚型受限。20%的患者存在可检测到的血清副蛋白。在植入后平均87个月的随访期间，25名患者中有11名患者在确诊后平均36个月内失去了主要是由于PGNMID的同种异体移植物。中位移植物存活时间为92个月。移植肾丢失的独立预测因素是峰值蛋白尿程度较高和从植入到诊断的时间较长。16例患者接受免疫抑制治疗，60%的患者蛋白尿减少50%以上，13例患者中9例肾小球病理得到改善。然而，44%的应答者随后复发。因此，PGNMID在早期发生的肾移植中复发率很高，通过常规活检提高了检测能力。移植结果受到保护，因为近一半的患者在确诊后三年内失去了移植物。因此，有必要对这种疾病采取更好的治疗策略。
The characteristics of allograft proliferative glomerulonephritis with monoclonal immunoglobulin G deposits (PGNMID) are not well defined. To better characterize this disease we retrospectively identified 26 patients with allograft PGNMID, including 16 followed with early protocol biopsies. PGNMID was found to be a recurrent disease in most (89%) patients. A diagnostic biopsy was done for proteinuria and/or increased creatinine in most patients. Median time from transplant to diagnostic biopsy was 5.5 months, with detection within three to four months post-transplant in 86% of patients. Mesangial proliferative glomerulonephritis was the most common pattern on the diagnostic biopsy with 89% of cases showing immunoglobulin G3 subtype restriction. A detectable serum paraprotein was present in 20% of patients. During a mean follow up of 87 months from implantation, 11 of 25 patients lost their allograft largely due to PGNMID within a mean of 36 months from diagnosis. Median graft survival was 92 months. Independent predictors of graft loss were a higher degree of peak proteinuria and longer time from implantation to diagnosis. Sixteen patients were treated with immunosuppressive therapy which resulted in over 50% reduction in proteinuria in 60%, and improvement of glomerular pathology in nine of 13 patients. However, 44% of responders subsequently relapsed. Thus, PGNMID has a high recurrence rate in renal allografts occurring early with detection enhanced by protocol biopsies. Graft outcome is guarded as nearly half of patients lose their graft within three years from diagnosis. Hence, there is a need for better treatment strategies for this disease.