Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Centre, Maastricht, The Netherlands.
Clin J Am Soc Nephrol. 2012 Jun;7(6):1010-7. doi: 10.2215/CJN.09030911. Epub 2012 Apr 5.
Chronic renal transplant dysfunction is histopathologically characterized by interstitial fibrosis and tubular atrophy. This study investigated the relative contribution of baseline donor, recipient, and transplant characteristics to interstitial fibrosis and tubular atrophy score at month 12 after renal transplantation.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This retrospective study includes all 109 consecutive recipients with adequate implantation and month 12 biopsies transplanted between April of 2003 and February of 2007. Immunosuppression regimen was tacrolimus and steroids (10 days) plus either sirolimus or mycophenolate mofetil.
Average interstitial fibrosis and tubular atrophy score increased from 0.70 to 1.65 (P<0.001). In an adjusted multiple linear regression analysis, interstitial fibrosis and tubular atrophy score at month 12 was significantly related to donor type (donors after cardiac death versus living donor had interstitial fibrosis and tubular atrophy score+0.41, 95% confidence interval=0.05-0.76, P=0.02), baseline interstitial fibrosis and tubular atrophy, and immunosuppression regimen. Because of interaction between the latter two variables (P=0.002), results are given separately: recipients with a baseline interstitial fibrosis and tubular atrophy score of zero had a 0.60 higher score at month 12 (95% confidence interval=0.09-1.10, P=0.02) when mycophenolate mofetil-treated, whereas recipients with a baseline interstitial fibrosis and tubular atrophy score more than zero had a 0.38 higher score at month 12 (95% confidence interval=0.01-0.74, P=0.04) when sirolimus-treated. A higher score at month 12 correlated with a lower estimated GFR (ρ=-0.45, P<0.001).
These findings suggest that histologic assessment of a preimplantation biopsy may guide choice of immunosuppresion to maximize transplant survival and its interaction with type of immunosuppression.
慢性肾移植功能障碍的组织病理学特征为间质纤维化和肾小管萎缩。本研究旨在探讨移植后 12 个月时，供体、受者和移植特征基线对间质纤维化和肾小管萎缩评分的相对贡献。
设计、地点、参与者和测量：这是一项回顾性研究，纳入了 2003 年 4 月至 2007 年 2 月期间接受充分移植并于移植后 12 个月接受活检的 109 例连续受者。免疫抑制方案为他克莫司和类固醇（10 天）联合西罗莫司或霉酚酸酯。
平均间质纤维化和肾小管萎缩评分从 0.70 增加到 1.65（P<0.001）。在调整后的多元线性回归分析中，移植后 12 个月的间质纤维化和肾小管萎缩评分与供体类型（心脏死亡供体与活体供体相比，间质纤维化和肾小管萎缩评分增加 0.41，95%置信区间=0.05-0.76，P=0.02）、基线间质纤维化和肾小管萎缩以及免疫抑制方案显著相关。由于后两个变量之间存在交互作用（P=0.002），因此分别给出结果：基线间质纤维化和肾小管萎缩评分为 0 的受者，霉酚酸酯治疗时 12 个月时的评分增加 0.60（95%置信区间=0.09-1.10，P=0.02），而基线间质纤维化和肾小管萎缩评分大于 0 的受者，西罗莫司治疗时 12 个月时的评分增加 0.38（95%置信区间=0.01-0.74，P=0.04）。12 个月时的评分较高与估算肾小球滤过率（eGFR）较低相关（ρ=-0.45，P<0.001）。
这些发现表明，移植前活检的组织学评估可能有助于指导免疫抑制方案的选择，以最大限度地提高移植存活率，并与其与免疫抑制方案的相互作用相关。
