Cosio F G, Gloor J M, Sethi S, Stegall M D
Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic and Foundation, Rochester, MN, USA.
Am J Transplant. 2008 Mar;8(3):492-6. doi: 10.1111/j.1600-6143.2007.02104.x.
Transplant glomerulopathy (TG) is a histologic entity described more than four decades ago. In the last few years, our understanding of TG has improved significantly. Current evidence supports the postulate that TG is a unique pathologic and pathogenic entity distinct from other forms of chronic allograft injury. Detailed electron microscopic studies have shown basement membrane abnormalities in glomerular and peritubular capillaries, indicating that this is a disease of the entire renal capillary network. Staining biopsies for the complement fragment, C4d, showed positivity in subgroups of TG, suggesting the participation of antidonor antibodies. Consistent with this postulate, the incidence of TG is increased in patients with antidonor HLA antibodies prior to the transplant. The use of surveillance biopsies has demonstrated that TG can develop during the first few months after transplantation, although it may remain clinically quiescent for several years. However, TG is progressive, leading to reduced graft survival. Recent studies demonstrated a close association between TG and anti-HLA class II antibodies. Current therapies for TG are likely of limited value. However, it is also likely that an improved understanding of TG pathogenesis will result in the development of effective therapies for this form of progressive kidney allograft damage.
移植肾小球病（TG）是一种四十多年前就已被描述的组织学实体。在过去几年中，我们对TG的认识有了显著提高。目前的证据支持这样一种假设，即TG是一种独特的病理和致病实体，有别于其他形式的慢性移植肾损伤。详细的电子显微镜研究显示肾小球和肾小管周围毛细血管的基底膜异常，表明这是一种累及整个肾毛细血管网络的疾病。对补体片段C4d进行染色的活检显示，TG亚组呈阳性，提示抗供体抗体的参与。与这一假设一致的是，移植前有抗供体HLA抗体的患者中TG的发生率增加。监测活检表明，TG可在移植后的头几个月内发生，尽管它可能在临床上保持数年静止状态。然而，TG是进行性的，会导致移植肾存活期缩短。最近的研究表明TG与抗HLA II类抗体密切相关。目前针对TG的治疗可能价值有限。然而，对TG发病机制的进一步了解也有可能促成针对这种进行性移植肾损伤形式的有效治疗方法的开发。
