De Novo Donor-Specific Antibody at the Time of Kidney Transplant Biopsy Associates with Microvascular Pathology and Late Graft Failure
De Novo Donor-Specific Antibody at the Time of Kidney Transplant Biopsy Associates with Microvascular Pathology and Late Graft Failure
复制标题
DOI：
10.1111/j.1600-6143.2009.02800.x
复制
发表时间：
2009-11-01
影响因子：
8.8
通讯作者：
Halloran, P. F.
中科院分区：
文献类型：
--
作者：
Hidalgo, L. G.;Campbell, P. M.;Halloran, P. F.
我们研究了接受肾移植活检的患者血清中的新生供体特异性抗体（DSA）是否与活检中的特定组织学病变和预后相关。145例患者在移植后7天至31年活检时进行DSA评估。54例（37%）患者检测到DSA，其中32例为新发DSA。新生DSA在晚期活检患者中更常见（34%），而在早期活检患者中更常见（4%），通常单独针对II级或I级和II级，但很少单独针对I级。微循环炎症（肾小球炎、毛细血管炎）和损伤（肾小球病变、毛细血管基底膜多层）及C4d染色与新生DSA相关。然而，疤痕程度、动脉纤维化和小管间质炎症与新发DSA的存在无关。新生DSA与活检后移植物存活率降低相关。因此，在临床适应症晚期活检时重新进行DSA主要针对II级，并且与活检中的微循环改变和随后的移植物失败有关。我们建议在所有晚期肾移植活检中仔细评估新生DSA，特别是II级DSA。
We studied whether de novo donor-specific antibodies (DSA) in sera from patients undergoing kidney transplant biopsies associate with specific histologic lesions in the biopsy and prognosis. DSA were assessed in 145 patients at the time of biopsy between 7 days to 31 years posttransplant. DSA was detected in 54 patients (37%), of which 32 represented de novo DSA. De novo DSA was more frequent in patients having late biopsies (34%) versus early biopsies (4%), and was usually either against class II alone or class I and II but rarely against class I alone. Microcirculation inflammation (glomerulitis, capillaritis) and damage (glomuerulopathy, capillary basement membrane multilayering), and C4d staining were associated with de novo DSA. However, the degree of scarring, arterial fibrosis and tubulo-interstitial inflammation did not correlate with the presence of de novo DSA. De novo DSA correlated with reduced graft survival after the biopsy. Thus, de novo DSA at the time of a late biopsy for clinical indication is primarily against class II, and associates with microcirculation changes in the biopsy and subsequent graft failure. We propose careful assessment of de novo DSA, particularly against class II, be performed in all late kidney transplant biopsies.