Early Subclinical Rejection as a Risk Factor for Late Chronic Humoral Rejection
Early Subclinical Rejection as a Risk Factor for Late Chronic Humoral Rejection
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DOI：
10.1097/tp.0b013e31823bb647
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发表时间：
2012-01-15
期刊：
影响因子：
6.2
通讯作者：
Seron, Daniel
中科院分区：
文献类型：
--
作者：
Moreso, Francesc;Carrera, Marta;Seron, Daniel
背景资料。方案活检中的亚临床排斥反应、间质纤维化和肾小管萎缩(IF/TA)与预后相关。我们研究了早期常规活检的组织学损害与晚期活检的组织学诊断之间的关系。材料和方法。我们回顾了1988至2006年间在移植后前6个月内进行常规活检的肾移植病例。活检按照Banff标准进行评估，C4D染色可用于病因的活检。在517例肾移植患者中，109例因病因行肾活检，病理诊断如下：慢性体液排斥(CHR)44例，IF/TA(42例)，原发疾病复发(11例)，新发肾小球肾炎(7例)，T细胞介导排斥反应(4例)，多瘤病毒肾病(1例)。慢性肾移植患者的再移植比例(15.9%比2.3%，P=0.058)和亚临床排斥反应发生率(52.3%比28.6%，P=0.0253)明显高于IF/TA患者。供体和受体的人口统计特征和常规活检时的临床数据在两组之间没有差异。Logistic回归分析显示，亚临床排斥反应(相对危险度2.52，95%可信区间1.1~6.3，P=0.047)与再次移植无关。早期方案活检中的亚临床排斥反应与迟发的慢性排斥反应有关。
Background. Subclinical rejection and interstitial fibrosis and tubular atrophy (IF/TA) in protocol biopsies are associated with outcome. We study the relationship between histologic lesions in early protocol biopsies and histologic diagnoses in late biopsies for cause.Materials and Methods. Renal transplants with a protocol biopsy performed within the first 6 months posttransplant between 1988 and 2006 were reviewed. Biopsies were evaluated according to Banff criteria, and C4d staining was available in biopsies for cause.Results. Of the 517 renal transplants with a protocol biopsy, 109 had a subsequent biopsy for cause which showed the following histological diagnoses: chronic humoral rejection (CHR) (n = 44), IF/TA (n = 42), recurrence of the primary disease (n = 11), de novo glomerulonephritis (n = 7), T-cell-mediated rejection (n = 4), and polyoma virus nephropathy (n = 1). The proportion of retransplants (15.9% vs. 2.3%, P = 0.058) and the prevalence of subclinical rejection were higher in patients with CHR than in patients with IF/TA (52.3% vs. 28.6%, P = 0.0253). Demographic donor and recipient characteristics and clinical data at the time of protocol biopsy were not different between groups. Logistic regression analysis showed that subclinical rejection (relative risk, 2.52; 95% confidence interval, 1.1-6.3; P = 0.047) but not retransplantation (relative risk, 6.7; 95% confidence interval, 0.8 - 58.8; P = 0.085) was associated with CHR.Conclusion. Subclinical rejection in early protocol biopsies is associated with late appearance of CHR.