Ji Shuming, Liu Min, Chen Jinsong, Yin Liping, Sha Guozhu, Chen Huiping, Liu Zhihong, Li Leishi
Research Institute of Nephrology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
Clin Transplant. 2004 Oct;18(5):536-40. doi: 10.1111/j.1399-0012.2004.00206.x.
To investigate the fate of the mesangial IgA deposits in the donor kidney after allograft transplantation.
Routine pre-transplant cadaveric donor kidney biopsy and repeated renal biopsies were performed at months 1, 3, and 6 after renal transplantation. The patients, 342 in number, were divided into IgA positive deposition kidney group (group A, n = 83) and non-IgA deposition kidney group (group B, n = 259). There were no significant differences between the two groups' sex, age, time of hemodialysis, warm ischemia time, cold ischemia time, complement-dependent cytotoxicity, level of panel-reactive assay, and the distribution of original disease.
Recipients in group A received donor kidney with glomerular mesangial proliferation and marked diffuse granular IgA deposition. All of them showed edema, nephrotic range protienuria, microhematuria, hypoalbuminemia, hypertension, and delayed graft function. Borderline change was higher in group A than in group B, 37.3 and 16.2% (p < 0.001), respectively. Acute allograft rejection was higher in group A than in group B, 31.3 and 19.3% (p < 0.001), respectively. The glomerular mesangial IgA deposits gradually disappeared from the mesangial regions in grafts of acute rejection. Graft survival in both groups was not significant, being 93.8 and 95.6% in 1 yr, and 86.7 and 88.3% in 3 yr.
Clinical features of the recipients which received from donor kidney with glomerular mesangial proliferation and marked diffuse granular IgA deposition: edema, proteinuria, microhematuria, hypoalbuminemia, hypertension, and delayed graft function. The presence of IgA deposits on donated kidney, by a possible increase of the immunogenicity of these kidneys, might be a cause of increased rejection. There were no significant differences between the two groups on long-term allograft survival.
研究同种异体肾移植后供肾中系膜IgA沉积物的转归。
在肾移植前对尸体供肾进行常规活检，并在肾移植后1、3和6个月进行重复肾活检。342例患者分为IgA阳性沉积肾组（A组，n = 83）和非IgA沉积肾组（B组，n = 259）。两组在性别、年龄、血液透析时间、热缺血时间、冷缺血时间、补体依赖性细胞毒性、群体反应性抗体水平及原发病分布方面无显著差异。
A组受者接受的供肾有肾小球系膜增生和明显的弥漫性颗粒状IgA沉积。他们均表现为水肿、肾病范围蛋白尿、镜下血尿、低白蛋白血症、高血压及移植肾功能延迟恢复。A组边缘性改变高于B组，分别为37.3%和16.2%（p < 0.001）。A组急性移植肾排斥反应高于B组，分别为31.3%和19.3%（p < 0.001）。在急性排斥反应的移植物中，肾小球系膜IgA沉积物逐渐从系膜区消失。两组的移植肾存活率无显著差异，1年时分别为93.8%和95.6%，3年时分别为86.7%和88.3%。
接受有肾小球系膜增生和明显弥漫性颗粒状IgA沉积的供肾的受者的临床特征为：水肿、蛋白尿、镜下血尿、低白蛋白血症、高血压及移植肾功能延迟恢复。供肾中IgA沉积物的存在可能通过增加这些肾脏的免疫原性而成为排斥反应增加的一个原因。两组在长期移植肾存活方面无显著差异。
