Peritubular capillaritis in early renal allograft is associated with the development of chronic rejection and chronic allograft nephropathy
Peritubular capillaritis in early renal allograft is associated with the development of chronic rejection and chronic allograft nephropathy
复制标题
早期同种异体移植肾中的管周毛细血管炎与慢性排斥反应和慢性同种异体移植肾病的发生有关
作者：
K. Aita;Y. Yamaguchi;S. Horita;M. Ohno;K. Tanabe;S. Fuchinoue;S. Teraoka;H. Toma
摘要： 管周毛细血管炎（PTCitis）已被认为是急性/活动性同种异体移植排斥反应的一种形式，并已提出其与体液免疫的关系。然而，其机制仍有待完全阐明，并且没有评估活检同种异体移植物中 PTC 炎程度的标准。在这项研究中，我们首先评估了患有急性细胞排斥（ACR）和抗体介导的排斥（AbAR）的患者的早期同种异体移植物中PTC炎的程度。我们还纳入了没有 ACR 和/或 AbAR 证据的患者。接下来，我们调查了 PTC 炎是否持续存在，以及后续活检标本中是否存在管周毛细血管基底膜 (PTCBM) 增厚。我们采用了2003年第七届班夫同种异体移植病理学会议上提出的PTCitis评分系统。本研究总共纳入了53名患者。首次活检时，17 例显示 ACR，8 例显示 AbAR，16 例仅显示轻度 PTC 炎，14 例无明显病理改变。 AbAR组PTC评分最高，部分患者随访期间评分逐渐升高。在仅患有轻度 PTC 炎的组中也观察到类似的变化。在同种异体移植晚期，一半的 AbAR 患者出现慢性排斥反应（CR），且 PTCBM 评分是该组中最高的。令人惊讶的是，超过 30% 没有 ACR 和/或 AbAR 但仅有轻度 PTC 炎的患者出现 CR。在对照组中，只有少数表现出 CR 和/或慢性同种异体移植肾病 (CAN)。总之，很明显我们应该仔细监测早期同种异体移植物中的轻度 PTC 炎。此外，我们的数据还证明了PTC评分和PTCBM评分的有用性。
Abstract: Peritubular capillaritis (PTCitis) has been recognized as one form of acute/active allograft rejection, and its relation to humoral immunity has been suggested. However, its mechanisms remain to be fully clarified, and there are no criteria for evaluating the extent of PTCitis in a biopsied allograft. In this study, we first evaluated the extent of PTCitis in early allografts in patients presenting with acute cellular rejection (ACR) and antibody‐mediated rejection (AbAR). We also included patients who showed no evidence of ACR and/or AbAR. Next, we investigated whether or not PTCitis persisted and if peritubular capillary basement membrane (PTCBM) thickening was present in their follow‐up biopsy specimens. We adopted the scoring system of PTCitis, which was presented at the Seventh Banff Conference on Allograft Pathology in 2003. In total, 53 patients were included in this study. At first biopsy, 17 showed ACR, eight showed AbAR, 16 showed mild PTCitis only, and 14 were without significant pathologic changes. The PTC score was the highest in the AbAR group, and in some patients the score gradually increased during the follow‐up period. Similar changes were also observed in the group with mild PTCitis only. In late allografts, half of the patients with AbAR developed chronic rejection (CR), and the PTCBM score was the highest in that group. Surprisingly, CR was present in more than 30% of patients without ACR and/or AbAR but mild PTCitis only. In the control group, only a few showed CR and/or chronic allograft nephropathy (CAN). In conclusion, it became clear that we should carefully monitor for mild PTCitis in early allografts. In addition, our data also proved the usefulness of the PTC score and PTCBM score.
影响因子：
6.2
作者：
Vieira, CA;Agarwal, A;Pescovitz, MD
通讯作者：
Pescovitz, MD