Dept. of Oncology and Neurosciences, University of Chieti, Italy.
Int J Immunopathol Pharmacol. 2009 Oct-Dec;22(4):1001-7. doi: 10.1177/039463200902200415.
Features of acute rejection in dual kidney transplant have not been studied. The aim of this study is to compare acute rejections in dual kidney transplant recipients from elderly donors on different immunosuppressive protocols. Sixty-nine patients were evaluated: 28 received calcineurin inhibitor-based (group 1) and 41 received calcineurin inhibitor-free immunosuppression (group 2). Histology of all donor kidneys was evaluated before implantation. All rejections showed tubulitis in both groups, and were classified as T-cell mediated acute rejections. Incidence and Banff grade of rejections in the two groups were not significantly different. Late rejections however, were observed in group 1 (P < 0.01) whereas steroid-resistant rejections occurred in group 2 (P < 0.03). C4d deposition was only observed in group 2. Occurrence of acute rejection was significantly associated with graft loss due to interstitial fibrosis/tubular atrophy in both groups. In group 1 mean serum creatinine levels of patients with rejections at six months and one year were higher than those of patients without rejections (P < 0.03 and P < 0.009, respectively). In group 2 they were higher at six months (P < 0.01) but not at one year. In addition, graft loss due to interstitial fibrosis/tubular atrophy occurred in 3/28 patients in group 1 (10.7%, OR= 1.95, 95%CI 1.02-3.71), and in 1/41 patients in group 2 (2.4%, OR= 0.41, 95%CI 0.07-2.24). Taken together these results suggest better renal function in patients on calcineurin inhibitor-free immunosuppression. In conclusion, acute rejections were detrimental irrespective of the type of immunosuppression, but different features were observed with each therapy. A tailored approach should be advantageous for prevention and treatment of acute rejections.
双肾移植中急性排斥反应的特点尚未得到研究。本研究旨在比较老年供体来源的双肾移植受者在不同免疫抑制方案下的急性排斥反应。共评估了 69 例患者：28 例接受钙调神经磷酸酶抑制剂（CNI）为基础的免疫抑制方案（组 1），41 例接受 CNI 免费免疫抑制方案（组 2）。所有供肾在移植前均进行了组织学评估。两组的所有排斥反应均表现为肾小管炎，并被归类为 T 细胞介导的急性排斥反应。两组的排斥反应发生率和 Banff 分级无显著差异。然而，组 1 观察到迟发性排斥反应（P < 0.01），而组 2 发生了类固醇耐药性排斥反应（P < 0.03）。C4d 沉积仅在组 2 中观察到。两组中急性排斥反应的发生与间质纤维化/肾小管萎缩导致的移植物丢失显著相关。在组 1 中，有排斥反应的患者在 6 个月和 1 年时的血清肌酐水平均高于无排斥反应的患者（P < 0.03 和 P < 0.009）。在组 2 中，6 个月时的水平更高（P < 0.01），但 1 年时无差异。此外，组 1 中有 3 例（10.7%）患者因间质纤维化/肾小管萎缩导致移植物丢失（OR = 1.95，95%CI 1.02-3.71），组 2 中有 1 例（2.4%）患者因间质纤维化/肾小管萎缩导致移植物丢失（OR = 0.41，95%CI 0.07-2.24）。综合这些结果表明，无 CNI 免疫抑制的患者肾功能更好。总之，急性排斥反应无论免疫抑制类型如何都有不良影响，但每种治疗方法的特点不同。个体化治疗方法对预防和治疗急性排斥反应可能是有利的。
