胰腺移植失败后胰肾联合移植受者的移植肾功能障碍：早期和晚期方案活检分析。

Kidney graft dysfunction in simultaneous pancreas-kidney recipients after pancreas failure: analysis of early and late protocol biopsies.

机构信息

Service de Néphrologie et Transplantation, Hôpital Saint-Louis, Paris, France.

出版信息

Clin Transplant. 2013 May-Jun;27(3):E249-55. doi: 10.1111/ctr.12095. Epub 2013 Feb 13.

DOI:10.1111/ctr.12095

PMID:23406495

Abstract

BACKGROUND

Kidney graft survival in simultaneous pancreas-kidney (SPK) recipients is known to decrease after pancreas graft failure.

METHODS

Sixty-three consecutive SPK recipients were retrospectively reviewed. Kidney graft function and proteinuria were evaluated at three months after the transplantation and at last follow-up. Histopathologic findings of protocol biopsies performed three months and one yr after transplantation were analyzed.

RESULTS

Twelve patients lost the pancreas graft. Donors' characteristics were similar in patients with or without pancreas failure. After a median follow-up of 36 months, mean eGFR with a functional pancreas was 69.5 mL/min/1.73 m² vs. 56.3 mL/min/1.73 m² (p = 0.01) after pancreas loss. Patients who lost pancreas had a median proteinuria of 0.28 g vs. 0.13 g per 24 h (p = 0.02). Analysis of three-month protocol biopsies revealed more frequent isolated glomerulitis after pancreas failure (p = 0.0001), without peritubular capillaritis or C4d deposition. No donor-specific anti-HLA antibodies were detectable in these patients. Chronic tubulointerstitial changes were more frequent in patients with pancreas loss. There was no evidence of diabetic nephropathy recurrence.

CONCLUSION

SPK recipients develop an early kidney graft dysfunction after pancreas failure. Histopathologic findings revealed frequent glomerulitis without antibody-mediated rejection and early chronic changes.

摘要

背景

已知在胰肾联合移植（SPK）受者中，胰腺移植物衰竭后，肾移植物存活率会下降。

方法

回顾性分析了 63 例连续的 SPK 受者。在移植后 3 个月和最后一次随访时评估了肾移植物功能和蛋白尿。分析了移植后 3 个月和 1 年进行的方案活检的组织病理学发现。

结果

12 例患者失去了胰腺移植物。发生胰腺衰竭的患者和未发生胰腺衰竭的患者的供者特征相似。中位随访 36 个月后，有功能胰腺的患者平均 eGFR 为 69.5 mL/min/1.73 m²，而胰腺丧失后为 56.3 mL/min/1.73 m²（p=0.01）。失去胰腺的患者蛋白尿中位数为 0.28 g/24 h，而有功能胰腺的患者为 0.13 g/24 h（p=0.02）。对 3 个月方案活检的分析显示，胰腺衰竭后孤立性肾小球肾炎更为常见（p=0.0001），但无肾小管周围毛细血管炎或 C4d 沉积。这些患者中未检测到供体特异性抗 HLA 抗体。与有胰腺移植物的患者相比，发生胰腺移植物丧失的患者慢性肾小管间质变化更为频繁。没有证据表明糖尿病肾病复发。