Department of Pathology, Oregon Health & Science University, Portland, OR, United States.
Pathol Res Pract. 2011 Jan 15;207(1):15-23. doi: 10.1016/j.prp.2010.10.001. Epub 2010 Nov 9.
Glomerular fibrin thrombi may be an early indication of antibody-mediated rejection in renal allograft biopsies. However, fibrin thrombi have a broad differential; thus, we sought to evaluate the etiology and implications of glomerular fibrin thrombi in allograft biopsies of blood group and cytotoxic crossmatch compatible renal allografts. Biopsies were identified from the pathology files of Oregon Health & Science University. Detailed histopathologic findings were retrospectively correlated with clinical data, treatment, and outcome. Sixteen early posttransplant biopsies had glomerular fibrin thrombi, including three surveillance biopsies. Six of 16 biopsies had no other histopathologic findings; 5/16 had glomerulitis and peritubular capillaritis; 4/16 had concomitant cellular vascular rejection; one had parenchymal infarction. C4d staining was positive in 4/16 cases. Most patients were treated with IVIg and plasmapheresis, others with rapamycin, thymoglobulin, or rituximab. At an average follow-up of 62 months, 8 patients with functioning grafts had a mean serum creatinine of 1.4 mg/dL (122 μmol/L). Antibody-mediated rejection is an important consideration in blood group compatible allograft biopsies with glomerular fibrin thrombi, even with C4d-negative biopsies. However, multidisciplinary evaluation is necessary, given other etiologies, including drug toxicity, hemolytic-uremia syndrome, and large vessel thrombosis. Despite aggressive treatment, both short and long-term graft survival may be compromised.
肾小球纤维蛋白血栓可能是肾移植活检中抗体介导排斥反应的早期迹象。然而，纤维蛋白血栓的鉴别诊断广泛，因此，我们试图评估在血型和细胞毒性交叉匹配相容的肾移植活检中肾小球纤维蛋白血栓的病因和意义。活检标本来自俄勒冈健康与科学大学的病理档案。回顾性地将详细的组织病理学发现与临床数据、治疗和结果相关联。16 例早期移植后活检标本中有肾小球纤维蛋白血栓，包括 3 例监测活检。16 例中有 6 例无其他组织病理学发现；5/16 例有肾小球肾炎和肾小管毛细血管炎；4/16 例同时伴有细胞性血管排斥反应；1 例有实质梗死。16 例中有 4 例 C4d 染色阳性。大多数患者接受 IVIg 和血浆置换治疗，其他患者接受雷帕霉素、胸腺球蛋白或利妥昔单抗治疗。在平均 62 个月的随访中，8 例有功能移植物的患者血清肌酐平均值为 1.4mg/dL（122μmol/L）。在血型相容的移植活检中，即使 C4d 阴性活检，抗体介导的排斥反应也是一个重要的考虑因素。然而，需要多学科评估，因为其他病因包括药物毒性、溶血尿毒综合征和大血管血栓形成。尽管进行了积极的治疗，短期和长期移植物存活率都可能受到影响。
