C4d Deposition without Rejection Correlates with Reduced Early Scarring in ABO-Incompatible Renal Allografts
C4d Deposition without Rejection Correlates with Reduced Early Scarring in ABO-Incompatible Renal Allografts
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DOI：
10.1681/asn.2008030279
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发表时间：
2009-01-01
影响因子：
13.6
通讯作者：
Montgomery, Robert A.
中科院分区：
文献类型：
--
作者：
Haas, Mark;Segev, Dorry L.;Montgomery, Robert A.
肾小管周围毛细血管中的 C4d 沉积是肾移植受者中抗供体抗体存在的特异性标志物，通常与传统同种异体移植物中抗体介导的排斥反应 (AMR) 相关。然而，在 ABO 不相容的移植物中，管周毛细血管 C4d 经常出现在缺乏 AMR 组织学特征的方案活检中； C4d 在这种情况下的重要性仍不清楚。为了解决这个问题，我们对 33 名接受 ABO 不相容同种异体肾移植（脱敏后）的患者的数据进行了回顾性审查。每个受者在移植后 1 和/或 3 和 6 个月进行活检，28 名受者在移植后 12 个月进行活检。 21 名患者（A 组）在其初始方案活检中具有强烈的弥漫性管周毛细血管 C4d 染色，没有 AMR 或细胞排斥的组织学证据。其余 12 名患者（B 组）局灶性管周毛细血管 C4d 染色呈阴性或弱。三个移植物（B 组中有两个）丢失，但不是由于 AMR 造成的。排除这三名患者，两组在移植后 6 个月和 12 个月以及最后一次随访时的血清肌酐水平相似；然而，根据班夫慢性指数总和评分，A 组受者在移植后第一年的总体慢性变化明显少于 B 组。这些结果表明，无排斥反应的弥漫性肾小管周围毛细血管 C4d 沉积与 ABO 血型不相容的同种异体肾移植物中疤痕形成的风险较低相关。这些结果对传统同种异体移植的普遍适用性仍然未知。
C4d deposition in peritubular capillaries is a specific marker for the presence of antidonor antibodies in renal transplant recipients and is usually associated with antibody-mediated rejection (AMR) in conventional allografts. In ABO-incompatible grafts, however, peritubular capillary C4d is often present on protocol biopsies lacking histologic features of AMR; the significance of C4d in this setting remains unclear. For addressing this, data from 33 patients who received ABO-incompatible renal allografts (after desensitization) were retrospectively reviewed. Protocol biopsies were performed at 1 and/or 3 and 6 mo after transplantation in each recipient and at 12 mo in 28 recipients. Twenty-one patients (group A) had strong, diffuse peritubular capillary C4d staining without histologic evidence of AMR or cellular rejection on their initial protocol biopsies. The remaining 12 patients (group B) had negative or weak, focal peritubular capillary C4d staining. Three grafts (two in group B) were lost but not as a result of AMR. Excluding these three patients, serum creatinine levels were similar in the two groups at 6 and 12 mo after transplantation and at last follow-up; however, recipients in group A developed significantly fewer overall chronic changes, as scored by the sum of Banff chronic indices, than group B during the first year after transplantation. These results suggest that diffuse peritubular capillary C4d deposition without rejection is associated with a lower risk for scarring in ABO-incompatible renal allografts; the generalizability of these results to conventional allografts remains unknown.