Lerut Evelyne, Naesens Maarten, Kuypers Dirk R, Vanrenterghem Yves, Van Damme Boudewijn
Department of Morphology and Molecular Pathology, University Hospitals Leuven, Leuven, Belgium.
Transplantation. 2007 Jun 15;83(11):1416-22. doi: 10.1097/01.tp.0000266676.10550.70.
Peritubular capillaritis has been associated with chronic rejection, but the characteristics of subclinical lesions in peritubular capillaries are unknown.
Fifty-three renal allograft recipients underwent a protocol biopsy at both 3 and 12 months after transplantation. Subclinical chronic antibody-mediated rejection (CAMR) at 1 year was diagnosed when three or more of five criteria were present: basement membrane multilayering of peritubular capillaries (MLPTC), transplant glomerulopathy, increase in intimal fibrosis between 3 and 12 months, C4d deposition in peritubular capillaries, and the presence of anti-human leukocyte antigen antibodies.
Six (11.3%) patients met the criteria of CAMR. MLPTC was the most sensitive (83.3%) and specific (89.1%) histological criterion (P=0.0008). Five patients had peritubular capillaritis at their 3-month biopsy. They all developed MLPTC at 1 year (P<0.0001). Three of the patients with early peritubular capillaritis met the criteria of CAMR at 1 year (P=0.0002).
Through early detection of subclinical peritubular capillaritis, renal allograft recipients who are at risk for development of MLPTC might be identified. Larger series are needed to confirm these preliminary findings, but this report suggests peritubular capillaritis as an early detection marker for patients at risk for CAMR.
肾小管周围毛细血管炎与慢性排斥反应相关，但肾小管周围毛细血管亚临床病变的特征尚不清楚。
53例肾移植受者在移植后3个月和12个月接受了方案活检。当出现以下五项标准中的三项或更多项时，诊断为1年时的亚临床慢性抗体介导的排斥反应（CAMR）：肾小管周围毛细血管基底膜多层化（MLPTC）、移植性肾小球病、3至12个月内膜纤维化增加、肾小管周围毛细血管C4d沉积以及抗人白细胞抗原抗体的存在。
6例（11.3%）患者符合CAMR标准。MLPTC是最敏感（83.3%）和特异（89.1%）的组织学标准（P = 0.0008）。5例患者在3个月活检时出现肾小管周围毛细血管炎。他们在1年时均出现MLPTC（P < 0.0001）。3例早期肾小管周围毛细血管炎患者在1年时符合CAMR标准（P = 0.0002）。
通过早期检测亚临床肾小管周围毛细血管炎，可能识别出有发生MLPTC风险的肾移植受者。需要更大规模的系列研究来证实这些初步发现，但本报告提示肾小管周围毛细血管炎可作为CAMR风险患者早期检测的标志物。
