Miyagi Moriatsu, Ishikawa Yukio, Mizuiri Sonoo, Aikawa Atsushi, Ohara Takehiro, Hasegawa Akira
Department of Nephrology, Toho University, Tokyo, Japan.
Clin Transplant. 2005 Aug;19(4):456-65. doi: 10.1111/j.1399-0012.2005.00303.x.
To determine the significance of early subclinical rejection of renal allografts, we reviewed 127 biopsy specimens obtained soon after transplantation. Histological finding was categorized according to a modification of the Banff scheme as: acute rejection (AR), borderline changes (BL); non-specific inflammatory changes, (NI) and no rejection (NR). Subclinical rejection was defined as AR, BL or NI. Patients with BL or NI were divided into two groups; one was treated with high-dose methylprednisolone (MP), the other remained untreated. Freedom from chronic allograft dysfunction (defined as non-doubling of serum creatinine 5 yr after transplantation) was significantly more frequent in the NR group (89%) than in the BL (70%) and AR (64%) groups. At 1 yr after transplantation, mean serum creatinine had increased significantly only in the untreated group (p < 0.05), and re-biopsy showed that interstitial fibrosis had developed to a significantly greater extent in the untreated group than in the treated group (p < 0.01). Subclinical rejection in the early protocol biopsies correlated closely with subsequent allograft dysfunction. High-dose MP treatment for early subclinical rejection may be effective in suppressing the development of interstitial fibrosis at 1 yr after transplantation.
为了确定肾移植早期亚临床排斥反应的意义，我们回顾了127份移植后不久获取的活检标本。组织学检查结果根据改良的班夫分类法分为：急性排斥反应（AR）、临界改变（BL）、非特异性炎症改变（NI）和无排斥反应（NR）。亚临床排斥反应定义为AR、BL或NI。BL或NI患者分为两组；一组接受大剂量甲基强的松龙（MP）治疗，另一组未接受治疗。无慢性移植肾功能障碍（定义为移植后5年血清肌酐未翻倍）在NR组（89%）比BL组（70%）和AR组（64%）更常见。移植后1年，仅未治疗组的平均血清肌酐显著升高（p<0.05），再次活检显示未治疗组间质纤维化的发展程度显著高于治疗组（p<0.01）。早期方案活检中的亚临床排斥反应与随后的移植肾功能障碍密切相关。对早期亚临床排斥反应进行大剂量MP治疗可能有效抑制移植后1年间质纤维化的发展。
