Department of Nephrology and Transplantation, University Hospital, Poitiers, France.
Am J Transplant. 2011 Oct;11(10):2153-61. doi: 10.1111/j.1600-6143.2011.03695.x. Epub 2011 Aug 22.
The long-term impact of subclinical acute rejection (SCAR) on renal graft function remains poorly understood. Furthermore, the interpretation of borderline lesions is difficult and their incidence is variable. The aim of this study was to analyze the characteristics of subclinical inflammation (SCI) in protocol biopsies performed 1-year after renal transplantation. SCI was defined as the presence of borderline lesions or SCAR according to the Banff 2005 classification. The patients included were a subpopulation of the CONCEPT study in which patients were randomized 3 months after transplantation to receive either sirolimus (SRL) or cyclosporine A (CsA) in combination with mycophenolate mofetil. At 1 year, we observed SCI in 37 of the 121 patients observed with an evaluable biopsy. The incidence was more frequent in the SRL group (SRL 45.2% vs. CsA 15.3%). At 30 months , SCI was associated with a significantly lower level of estimated glomerular filtration rate (mean MDRD 50.8 [±13.3] vs. 57.7 [±16.3] mL/min/1.73 m(2) , p = 0.035). In conclusion, SCI at 1-year posttransplantation is associated with worsening renal function and is more frequent in SRL-treated patients. Therefore, evaluation of SCI may be a valuable tool to allow the optimization of immunosuppressive regimens.
亚临床急性排斥反应 (SCAR) 对肾移植物功能的长期影响仍知之甚少。此外，边界病变的解释较为困难，且其发生率存在差异。本研究旨在分析肾移植后 1 年时方案活检中出现的亚临床炎症 (SCI) 的特征。SCI 根据 2005 年 Banff 分类标准定义为存在边界病变或 SCAR。纳入的患者是 CONCEPT 研究的一个亚组，其中患者在移植后 3 个月时被随机分配接受西罗莫司 (SRL) 或环孢素 A (CsA) 联合吗替麦考酚酯。在 1 年时，我们在 121 例可评估活检的患者中观察到 37 例存在 SCI。SRL 组的发生率更高（SRL 45.2% vs. CsA 15.3%）。在 30 个月时，SCI 与估算肾小球滤过率（MDRD）显著降低相关（平均 MDRD 50.8[±13.3] vs. 57.7[±16.3]mL/min/1.73m(2)，p=0.035）。总之，移植后 1 年时的 SCI 与肾功能恶化相关，且在 SRL 治疗的患者中更为常见。因此，SCI 的评估可能是优化免疫抑制方案的一种有价值的工具。
