Loupy A, Suberbielle-Boissel C, Hill G S, Lefaucheur C, Anglicheau D, Zuber J, Martinez F, Thervet E, Méjean A, Charron D, Duong van Huyen J P, Bruneval P, Legendre C, Nochy D
INSERM UMR 872, Université Paris Descartes, Paris, France.
Am J Transplant. 2009 Nov;9(11):2561-70. doi: 10.1111/j.1600-6143.2009.02813.x. Epub 2009 Sep 22.
This study describes clinical relevance of subclinical antibody-mediated rejection (SAMR) in a cohort of 54 DSA-positive kidney transplant recipients receiving a deceased donor. In 3 months screening biopsies, 31.1% of patients met the criteria of SAMR. A total of 48.9% had an incomplete form of SAMR (g+/ptc+/C4d-negative) whereas 20% had no humoral lesions. Patients with SAMR at 3 months had at 1 year: a higher C4d score, ptc score, and arteriosclerosis score, higher rate of IFTA (100% vs. 33.3%, p < 0.01) and a higher rate of transplant glomerulopathy (43% vs. 0%, p = 0.02) compared to patients without 3-month SAMR. Patients with SAMR at 3 months exhibited at 1 year a higher class II MFImax-DSA and a lower mGFR compared to patients without SAMR (39.2 +/- 13.9 vs. 61.9 +/- 19.2 mL/min/1.73 m(2) respectively, p < 0.01). The group of patients with C4d-negative SAMR at 3 months developed more ptc and IFTA lesions, and lower GFR at 1 year in comparison to biopsies without humoral lesions. SAMR is a frequent entity in KTR with preexisting DSAs and promotes subsequent GFR impairment and development of chronic AMR. C4d-negative SAMR patients displayed an intermediate course between the no-SAMR group and the C4d+ SAMR group. Screening biopsies may be useful to recognize patients more likely to develop SAMR.
本研究描述了54例接受已故供体肾脏移植的DSA阳性受者队列中亚临床抗体介导排斥反应（SAMR）的临床相关性。在3个月的筛查活检中，31.1%的患者符合SAMR标准。共有48.9%的患者为不完全形式的SAMR（g+/ptc+/C4d阴性），而20%的患者无体液损伤。3个月时发生SAMR的患者在1年时：与3个月时未发生SAMR的患者相比，C4d评分、ptc评分和动脉硬化评分更高，IFTA发生率更高（100%对33.3%，p<0.01），移植性肾小球病发生率更高（43%对0%，p = 0.02）。3个月时发生SAMR的患者在1年时与未发生SAMR的患者相比，II类MFImax-DSA更高，mGFR更低（分别为39.2±13.9与61.9±19.2 mL/min/1.73 m²，p<0.01）。与无体液损伤的活检相比，3个月时C4d阴性SAMR患者组在1年时出现更多的ptc和IFTA损伤，GFR更低。SAMR在存在预存DSA的肾移植受者中是一种常见情况，并促进随后的GFR损害和慢性AMR的发展。C4d阴性SAMR患者表现出介于无SAMR组和C4d阳性SAMR组之间的中间病程。筛查活检可能有助于识别更有可能发生SAMR的患者。
