Analysis of renal transplant protocol biopsies in ABO-incompatible kidney transplantation
Analysis of renal transplant protocol biopsies in ABO-incompatible kidney transplantation
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DOI：
10.1111/j.1600-6143.2007.02036.x
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发表时间：
2008-01-01
影响因子：
8.8
通讯作者：
Tanabe, K.
中科院分区：
文献类型：
--
作者：
Setoguchi, K.;Ishida, H.;Tanabe, K.
许多研究表明，协议活检具有预测能力。我们回顾性研究了48例ABO血型不合（ABO-I）移植受者的89例方案活检的组织学结果和C4d染色，并将结果与133例给予等效维持免疫抑制的ABO血型相容（ABO-C）移植受者的250例对照进行比较。其他研究表明，ABO-C移植物的亚临床排斥反应（临界和I级）在移植后逐渐减少。然而，在我们的研究中，在1、3和6-12个月时，ABO-I移植物的亚临床排斥反应分别为10%、14%和28%。在6-12个月时，轻度肾小管萎缩在ABO-C移植物中更常见，而两组间移植肾小球病的发生率无差异（ABO-C：7%; ABO-I：15%; p = 0.57）。在ABO-I移植中，单变量分析中移植肾小球病的危险因素为阳性组反应性（相对危险度，45.0; p < 0.01）和既往抗体介导的排斥反应史（相对危险度，17.9; p = 0.01）。此外，在94%的肾小管周围毛细血管中检测到C4d沉积，其中66%为弥漫性染色。然而，这种沉积与抗体介导的排斥反应无关。我们的结论是，在ABO-I型肾移植设置，C4d单独检测活检协议可能没有任何诊断或治疗的相关性。
Numerous studies have shown that protocol biopsies have predictive power. We retrospectively examined the histologic findings and C4d staining in 89 protocol biopsies from 48 ABO-incompatible (ABO-I) transplant recipients, and compared the results with those of 250 controls from 133 ABO-compatible (ABO-C) transplant recipients given equivalent maintenance immunosuppression. Others have shown that subclinical rejection (borderline and grade I) in ABO-C grafts decreased gradually after transplantation. In our study, however, subclinical rejection in the ABO-I grafts was detected in 10%, 14% and 28% at 1, 3 and 6-12 months, respectively. At 6-12 months, mild tubular atrophy was more common in the ABO-C grafts whereas the incidence of transplant glomerulopathy did not differ between the two groups (ABO-C: 7%; ABO-I: 15%; p = 0.57). In the ABO-I transplants, risk factors for transplant glomerulopathy in univariate analysis were positive panel reactivity (relative risk, 45.0; p < 0.01) and a prior history of antibody-mediated rejection (relative risk, 17.9; p = 0.01). Furthermore, C4d deposition in the peritubular capillaries was detected in 94%, with diffuse staining in 66%. This deposition, however, was not linked to antibody-mediated rejection. We conclude that, in the ABO-I kidney transplantation setting, detection of C4d alone in protocol biopsies might not have any diagnostic or therapeutic relevance.