Department of Pathology, MC 6101, AMB S-630, University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637, USA.
Clin J Am Soc Nephrol. 2011 Feb;6(2):395-403. doi: 10.2215/CJN.05870710. Epub 2010 Oct 21.
This study characterizes the pathologic and clinical relationships of thrombotic microangiopathy (TMA) to antibody-mediated rejection (AMR) in renal allograft biopsies.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Consecutive renal allograft biopsies, routinely stained for C4d over a period of 51 months (n=1101), were reviewed. For comparative analysis of histology and clinical features, additional patients with TMA and peritubular capillary (PTC) C4d (n=5) were combined with those identified in the 51-month period of review (n=6).
One hundred eighty-two of 1073 adequate biopsies from 563 allografts had PTC C4d in the study period. Six of 37 biopsies with TMA had PTC C4d (five at ≤90 days and one at 213 days). Early (≤90 days) C4d+ biopsies (n=5) had more frequent TMA (11.9% C4d+ versus 3.4% C4d-; odds ratio, 3.84; P=0.03). Graft loss was significantly greater in an early C4d+TMA+ group (n=5 study+2 archival patients) than in C4d+ controls without TMA (n=21) (57% versus 9.5%; P=0.02). Early TMA+C4d+ biopsies had more severe glomerulopathy and less severe arteriolopathy than TMA+C4d- and had more frequent neutrophilic capillaritis than TMA-C4d+ biopsies.
TMA was infrequent in this series of unselected, consecutive, renal allograft biopsies (3.4%). PTC C4d may be a significant risk factor for early TMA, and TMA is associated with glomerular thrombi and neutrophilic capillaritis. TMA in allografts with suspected AMR may portend a higher risk of graft loss.
本研究旨在描述肾移植活检中血栓性微血管病（TMA）与抗体介导的排斥反应（AMR）的病理和临床关系。
方法、设置、参与者和测量：回顾了连续的肾移植活检，在 51 个月的时间内常规染色 C4d（n=1101）。为了进行组织学和临床特征的比较分析，将另外 5 例伴有 TMA 和肾小管周毛细血管（PTC）C4d 的患者（n=5）与在 51 个月的研究期间确定的患者（n=6）合并。
在研究期间，563 例移植中有 1073 例足够的活检中有 182 例 PTC C4d。37 例 TMA 活检中有 6 例 PTC C4d（5 例在≤90 天，1 例在 213 天）。早期（≤90 天）C4d+活检（n=5）中 TMA 更常见（11.9% C4d+与 3.4% C4d-；比值比，3.84；P=0.03）。在早期 C4d+TMA+组（n=5 例研究+2 例存档患者）中，移植丢失率明显高于 C4d+无 TMA 对照组（n=21）（57%比 9.5%；P=0.02）。早期 TMA+C4d+活检比 TMA+C4d-和 TMA-C4d+活检有更严重的肾小球病和较轻的小动脉病，且更常伴有中性粒细胞性毛细血管炎。
在本系列未选择的连续肾移植活检中，TMA 较为少见（3.4%）。PTC C4d 可能是早期 TMA 的重要危险因素，TMA 与肾小球血栓形成和中性粒细胞性毛细血管炎有关。在疑似 AMR 的移植中，TMA 可能预示着更高的移植丢失风险。
