Long-Term Kidney Allograft Survival in Patients With Transplant Glomerulitis
Long-Term Kidney Allograft Survival in Patients With Transplant Glomerulitis
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DOI：
10.1097/tp.0000000000000606
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发表时间：
2015-02-01
期刊：
影响因子：
6.2
通讯作者：
Kliem, Volker
中科院分区：
文献类型：
--
作者：
Nabokow, Alexander;Dobronravov, Vladimir A.;Kliem, Volker
背景肾移植肾小球炎（G）与供体特异性抗体存在时的急性抗体介导的排斥反应（ABMR）相关。然而，长期预后的孤立G（isG）在没有供体特异性抗体或G与T细胞介导的排斥反应（TCMR）的组合仍然是未知的。方法. 70例G受者分为3组：isG组、G + TCMR组（G + TCMR）和G + ABMR组。对照组为无G的TCMRBanff I或II型患者（TCMR）和无排斥反应（NR）患者。采用Kaplan-Meier死亡删失生存曲线和考克斯回归分析移植物存活率。联合移植物存活终点定义为恢复透析或估计肾小球滤过率低于15 mL/min/1.73 m2。活检后中位随访时间为37（14; 77）个月。结果G组移植物存活率明显低于NR组和TCMR组。在isG、G + TCMR和ABMR组之间没有观察到显著差异。G + TCMR组移植物存活率低于TCMR组。在校正其他混杂因素后的多变量考克斯回归模型中，肾小球炎与移植物不良结局风险独立相关（风险比，4.52 [95%置信区间，2.37-8.68] vs对照组; P < 0.001）。结论.肾小球炎与移植物衰竭风险增加密切相关。不符合Banff急性/活动性ABMR标准的isG患者和伴有GTCMR的患者的移植物存活率与ABMR组相当。
Background. Renal transplant glomerulitis (G) is associated with acute antibody-mediated rejection (ABMR) in the presence of donor-specific antibodies. However, the long-term prognosis of isolated G (isG) in the absence of donor-specific antibodies or G in combination with T cell-mediated rejection (TCMR) remains unexplored. Methods. Seventy recipients with G were included in this retrospective study and subdivided into 3 groups: isG, G with TCMR (G + TCMR), and G with acute ABMR. The control groups were: patients with TCMR Banff type I or II without G (TCMR) and patients without rejection (NR). Kaplan-Meier death-censored survival plots and Cox regression were used to analyze graft survival. The combined graft survival endpoint was defined as a return to dialysis or estimated glomerular filtration rate less than 15 mL/min/1.73 m(2). The median follow-up was 37 (14; 77) months from biopsy. Results. Graft survival was significantly lower in patients with G than in the NR and TCMR groups. No significant differences were observed among the isG, G + TCMR, and ABMR groups. Graft survival was lower in the G + TCMR group than in the TCMR group. Glomerulitis was independently associated with the risk of adverse graft outcome in a multivariate Cox regression model adjusted for other confounders (hazard ratio, 4.52 [95% confidence interval, 2.37-8.68] vs controls; P < 0.001). Conclusions. Glomerulitis is strongly associated with increased risk of graft failure. Graft survival in patients with isG that do not meet the Banff criteria for acute/active ABMR and in patients with G accompanying TCMR is comparable to the ABMR group.