Significance of C4d Banff Scores in Early Protocol Biopsies of Kidney Transplant Recipients with Preformed Donor-Specific Antibodies (DSA)
Significance of C4d Banff Scores in Early Protocol Biopsies of Kidney Transplant Recipients with Preformed Donor-Specific Antibodies (DSA)
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DOI：
10.1111/j.1600-6143.2010.03364.x
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发表时间：
2011-01-01
影响因子：
8.8
通讯作者：
Legendre, C. H.
中科院分区：
文献类型：
--
作者：
Loupy, A.;Hill, G. S.;Legendre, C. H.
C4D-Banff评分在预制供体特异性抗体(DSA)肾移植受者的常规活检中的意义尚未确定。我们回顾了移植后3个月和1年从80例DSA+患者身上获得的157例活检。C4D Banff评分(1，2，3)与移植后3个月和1年微循环炎症(MI)显著增加、移植肾小球病变严重和II级DSA-MFI较高相关(P<；0.01)。微小C4D的损伤介于阴性和局限性之间，而局灶性和弥漫性C4D的微血管损伤程度相同。共有54%的患者在移植后3个月至1年之间有C4D评分的变化。累积(3个月+1年)C4D评分与长期肾功能恶化相关(p=0.006)。然而，C4D染色不是实质性疾病的敏感指标，55%的C4D阴性活检有伴发心肌梗死的证据。多变量分析显示，3个月时出现心肌梗死和II类DSA与慢性抗体介导的排斥进展风险增加四倍，与C4D无关(p<；0.05)。总之，移植后第一年C4D状态的大幅波动反映了一个动态的体液过程。然而，C4D可能不是一个足够灵敏的活动指标，MI和DSA是更可靠的不良结果预测指标。
The significance of C4d-Banff scores in protocol biopsies of kidney transplant recipients with preformed donor-specific antibodies (DSA) has not been determined. We reviewed 157 protocol biopsies from 80 DSA+ patients obtained at 3 months and 1 year post-transplant. The C4d Banff scores (1,2,3) were associated with significant increments of microcirculation inflammation (MI) at both 3 months and 1 year post-transplant, worse transplant glomerulopathy and higher class II DSA-MFI (p < 0.01). Minimal-C4d had injury intermediate between negative and focal, while focal and diffuse-C4d had the same degree of microvascular injury. A total of 54% of patients had variation of C4d score between 3 months and 1 year post-transplant. Cumulative (3 month + 1 year) C4d scores correlated with long-term renal function worsening (p = 0.006). However, C4d staining was not a sensitive indicator of parenchymal disease, 55% of C4d-negative biopsies having evidence of concomitant MI. Multivariate analysis demonstrated that the presence of MI and class II DSA at 3 months were associated with a fourfold increased risk of progression to chronic antibody-mediated rejection independently of C4d (p < 0.05). In conclusion, the substantial fluctuation of C4d status in the first year post-transplant reflects a dynamic humoral process. However, C4d may not be a sufficiently sensitive indicator of activity, MI and DSA being more robust predictors of bad outcome.