Sis B, Campbell P M, Mueller T, Hunter C, Cockfield S M, Cruz J, Meng C, Wishart D, Solez K, Halloran P F
Laboratory Medicine and Pathology, and Medicine, Division of Nephrology and Transplantation Immunology, University of Alberta, Edmonton, AB, Canada.
Am J Transplant. 2007 Jul;7(7):1743-52. doi: 10.1111/j.1600-6143.2007.01836.x.
To define the relative frequency of phenotypes of transplant glomerulopathy, we retrospectively reviewed the findings in 1036 biopsies for clinical indications from 1320 renal transplant patients followed in our clinics between 1997 and 2005. Transplant glomerulopathy, defined by double contours of glomerular basement membranes (D), was diagnosed in 53 biopsies (5.1%) from 41 patients (3.1%) at a median of 5.5 years post-transplant (range 3.8-381 months). In cases with D, we studied the frequency of circulating anti-HLA alloantibody (A), peritubular capillary basement membrane multilayering (B) and peritubular capillary C4d deposition (C). B was present in 48 (91%) of D biopsies. C4d staining by indirect immunofluorescence was detected in 18 of 50 D biopsies studied (36%). By Flow PRA Screening or ELISA, A was detected in 33 (70%) in 47 D cases with available sera, of which 28/33 or 85% were donor-specific. Class II (13/33) or class I and II (17/33) were more common than class I (3/33) antibodies. Thus 73% of transplant glomerulopathy has evidence of alloantibody-mediated injury (A and/or C), with ABCD and ABD being the common phenotypes in biopsies for cause. The remaining 27%, mostly BD, may be a different disease or a stage in which A and C are undetectable.
为了确定移植肾小球病的表型相对频率，我们回顾性分析了1997年至2005年间在我们诊所随访的1320例肾移植患者中1036例因临床指征进行活检的结果。移植肾小球病由肾小球基底膜双轨征（D）定义，在41例患者（3.1%）的53例活检（5.1%）中被诊断出，移植后中位时间为5.5年（范围3.8 - 381个月）。在有D表现的病例中，我们研究了循环抗HLA同种抗体（A）、肾小管周围毛细血管基底膜多层化（B）和肾小管周围毛细血管C4d沉积（C）的频率。B出现在48例（91%）有D表现的活检中。在所研究的50例有D表现的活检中，18例（36%）通过间接免疫荧光检测到C4d染色。通过流式PRA筛选或ELISA，在47例有可用血清的D病例中，33例（70%）检测到A，其中28/33或85%是供体特异性的。Ⅱ类抗体（13/33）或Ⅰ类和Ⅱ类抗体（17/33）比Ⅰ类抗体（3/33）更常见。因此，73%的移植肾小球病有同种抗体介导损伤的证据（A和/或C），ABCD和ABD是活检病因中的常见表型。其余27%，主要是BD，可能是一种不同的疾病或处于A和C检测不到的阶段。
