移植肾活检中常规发现过敏性紫癜性肾炎的组织学复发。

Histologic recurrence of Henoch-Schonlein Purpura nephropathy after renal transplantation on routine allograft biopsy.

机构信息

Universite Paris Descartes, Paris, France.

出版信息

Transplantation. 2011 Oct 27;92(8):907-12. doi: 10.1097/TP.0b013e31822e0bcf.

DOI:10.1097/TP.0b013e31822e0bcf

PMID:21869738

Abstract

BACKGROUND

Henoch-Schonlein Purpura nephropathy (HSPN) recurrence in renal transplant recipients (RTRs) has been reported in 35% of patients, leading in 11% of these patients to graft loss at 5 years. However, its true incidence is unknown. The aim of this study was to investigate this recurrence incidence using routine allograft biopsies (RBs).

METHODS

All RTRs with biopsy-proven HSP initial nephropathy were included (13 RTRs and 18 renal transplantations). At transplantation, the median age was 34 years, and 85% of RTRs were men. Overall, we analyzed 66 RBs that were routinely performed at 3 and 12 months after RT and when clinically indicated. Histologic recurrence was defined as the presence of IgA deposits within the mesangium and along the glomerular capillary walls.

RESULTS

After a median follow-up of 83 months (range, 13-232 months; interquartile range, 26-235 months), histologic recurrence was detected in 69% of patients and in 61% of grafts after a mean period of 24 months (range, 1-156 months). Clinical or biological signs were absent in all but one. Patient survival was 92.8%. Graft loss occurred in five cases, never were related to recurrence. At the last follow-up, the mean glomerular filtration rate was 48±14.2 mL/min/1.73 m(2); in patients with and without recurrence, the mean rates were 52.1±17.5 and 42.4±5.3 mL/min/1.73 m(2), respectively (P=0.27).

CONCLUSION

Histologic recurrence of HSPN after RT is frequently observed on routine RBs but is not associated with clinical consequences. The short-term prognosis of recurrence is good, but its long-term prognosis remains to be determined.

摘要

背景

曾报道肾移植受者（RTR）的过敏性紫癜性肾炎（HSPN）复发率为 35%，其中 11%的患者在 5 年内发生移植物丢失。然而，其真实发病率尚不清楚。本研究旨在通过常规移植肾活检（RB）来调查这种复发发生率。

方法

纳入所有经活检证实为 HSP 初始肾病的 RTR（13 例 RTR 和 18 例肾移植）。移植时，中位年龄为 34 岁，85%的 RTR 为男性。我们总共分析了 66 例 RB，这些 RB 在移植后 3 个月和 12 个月以及临床需要时常规进行。组织学复发定义为系膜和肾小球毛细血管壁内存在 IgA 沉积。

结果

中位随访 83 个月（范围 13-232 个月；四分位距 26-235 个月）后，69%的患者和 61%的移植物在平均 24 个月（范围 1-156 个月）后出现组织学复发。除 1 例外，所有患者均无临床或生物学表现。患者存活率为 92.8%。5 例发生移植物丢失，均与复发无关。在最后一次随访时，平均肾小球滤过率为 48±14.2 mL/min/1.73 m2；在有和无复发的患者中，分别为 52.1±17.5 和 42.4±5.3 mL/min/1.73 m2（P=0.27）。