Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.
Clin Transplant. 2012 Jul;26 Suppl 24:37-42. doi: 10.1111/j.1399-0012.2012.01639.x.
Transplant glomerulopathy (TG) is involved in the criteria of chronic active antibody-mediated rejection (c-AMR) in Banff '09 classification.
TG was diagnosed in 58 renal allograft biopsy specimens (BS) from 37 renal transplant patients.
Among 58 BS of TG, 27 BS were mild (cg1), 16 were moderate (cg2), and 15 were severe (cg3). Peritubular capillaritis was present in 49 (84%), transplant glomerulitis was seen in 47 BS (81%), interstitial fibrosis and tubular atrophy in 47 (81%) and the thickening of the peritubular capillary (PTC) basement membrane (PTCBM) in 44 (76%), and interstitial inflammation was present in 26 BS (45%). C4d deposition in PTC was presented in 32 BS (55%). The circulating anti-HLA alloantibody was detected in 38 times (76%), of which 27/38 (54%) were donor-specific antibodies. Deterioration of renal allografts' function after biopsies was seen in 12 patients (32%) with six of them lost their graft.
We suggest that histopathological changes of TG accompanying by transplant glomerulitis, peritubular capillaritis, the thickening of the PTCBM, and circulating anti-HLA antibodies might indicate c-AMR, even if C4d deposition in PTC is negative. The prognosis of the graft exhibiting TG was relatively good under the present immunosuppression protocol in short time.
移植肾小球病（TG）涉及到 Banff'09 分类中慢性活动性抗体介导的排斥反应（c-AMR）的标准。
在 37 名肾移植患者的 58 份肾移植活检标本（BS）中诊断出 TG。
在 58 份 TG BS 中，27 份为轻度（cg1），16 份为中度（cg2），15 份为重度（cg3）。49 份 BS 存在肾小管周围毛细血管炎（84%），47 份 BS 可见移植肾小球肾炎（81%），47 份 BS 存在间质纤维化和肾小管萎缩（81%），44 份 BS 可见肾小管周围毛细血管（PTC）基底膜（PTCBM）增厚（76%），26 份 BS 存在间质炎症（45%）。32 份 BS （55%）中存在 PTC 中的 C4d 沉积。在 38 次循环中检测到抗 HLA 同种异体抗体（76%），其中 27/38（54%）为供体特异性抗体。12 名患者（32%）在活检后出现肾功能恶化，其中 6 名患者失去了移植物。
我们建议，伴随移植肾小球肾炎、肾小管周围毛细血管炎、PTCBM 增厚和循环抗 HLA 抗体的 TG 组织病理学变化可能提示 c-AMR，即使 PTC 中的 C4d 沉积为阴性。在目前的免疫抑制方案下，在短时间内，表现出 TG 的移植物的预后相对较好。
