肾小管周围毛细血管中的局灶性C4d染色与肾移植存活：一项回顾性研究的结果

Focal C4d staining in peritubular capillaries and kidney graft survival: results of a retrospective study.

作者信息

Fior F, Nacchia F, Minicozzi A, Ghimenton C, Boschiero L

机构信息

First Surgical Clinic, Kidney Transplantation Center, Azienda Ospedaliero-Universitaria, Verona, Italy.

出版信息

Transplant Proc. 2010 May;42(4):1095-7. doi: 10.1016/j.transproceed.2010.03.105.

DOI:10.1016/j.transproceed.2010.03.105

PMID:20534232

Abstract

A diffuse positivity (>or=50%) of C4d in kidney graft peritubular capillaries (PTC) significantly correlates with the presence of acute or chronic antibody-mediated rejection. In contrast, significance of a "focal" deposit (10%-50%) is not yet completely defined. The purpose of this study was to assess the impact of focal positive C4d staining on graft survival. We retrospectively reviewed 63 renal biopsies in 54 kidney transplant recipients. They were performed between January 2005 and December 2008 because of graft impairement, namely, a significant increase in serum creatinine and/or urinary protein. C4d positivity was assessed by immunohistochemistry on paraffin-embedded sections, in combination with conventional histopathologic evaluation. Biopsies were classified as negative (<10%) versus with focal (10%-50%) or diffuse deposits (>50%). Cumulative survival was calculated by the Kaplan-Meier method, and Cox regression analysis was used for the multivariate analysis. Focal C4d staining in PTC significantly correlated with worse graft survival (P = .006), similarly to diffuse C4d staining. On multivariate analysis, focal C4d staining prognostically correlated with graft survival, but not recipient or donor age, prior transplantation, number of HLA mismatches or the presence of tubulitis in the sample. Focal C4d staining was associated with worse graft survival.

摘要

肾移植肾小管周围毛细血管（PTC）中C4d弥漫性阳性（≥50%）与急性或慢性抗体介导的排斥反应显著相关。相比之下，“局灶性”沉积（10%-50%）的意义尚未完全明确。本研究的目的是评估局灶性C4d染色阳性对移植物存活的影响。我们回顾性分析了54例肾移植受者的63份肾活检标本。这些活检标本于2005年1月至2008年12月期间因移植物功能损害而进行，即血清肌酐和/或尿蛋白显著增加。通过对石蜡包埋切片进行免疫组织化学检测并结合传统组织病理学评估来评估C4d阳性情况。活检标本分为阴性（<10%）、局灶性沉积（10%-50%）或弥漫性沉积（>50%）。采用Kaplan-Meier法计算累积生存率，并使用Cox回归分析进行多变量分析。PTC中局灶性C4d染色与移植物存活率较差显著相关（P = .006），与弥漫性C4d染色情况类似。多变量分析显示，局灶性C4d染色在预后方面与移植物存活相关，但与受者或供者年龄、既往移植史、HLA错配数或样本中是否存在肾小管炎无关。局灶性C4d染色与移植物存活率较差相关。