Larpparisuth N, Vongwiwatana A, Vareesangthip K, Cheunsuchon B, Parichatikanon P, Premasathian N
Division of Nephrology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Department of Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Transplant Proc. 2014;46(2):474-6. doi: 10.1016/j.transproceed.2013.12.022.
Acute antibody-mediated rejection (AMR) is a major cause of early kidney allograft dysfunction. This study was conducted to examine the clinicopathologic features and long-term outcomes of early AMR in our center.
We retrospectively reviewed all patients who underwent kidney transplantation between January 2005 and December 2012. Patients who had histopathologic features of AMR within 3 months after transplantation were enrolled.
Of 444 patients, early acute AMR was diagnosed in 25 patients (5.36%). Seventeen patients (68%) were highly sensitized. Histological analysis revealed acute vascular rejection and thrombotic microangiopathy in 21 (84%) and 6 (24%) patients, respectively. Staining of C4d in peritubular capillaries was detected in 6/20 patients (12%). All patients received plasma exchange (PE) 1.5 blood volume for 1-5 sessions followed by intravenous immunoglobulin (IVIG) 2 g/kg. Sixteen patients (64%) received 1-2 doses of rituximab 375 mg/m(2). We repeated treatment with PE and IVIG in refractory cases. Allografts could be rescued in 20 patients (80%) whereas 5 patients (20%) lost their grafts. Kaplan-Meier survival analysis revealed lower cumulative graft survival in the early AMR group compared with patients without early AMR (1 year survival rate of 80% vs 96% and 3 survival of 64% vs 80%; P < .001). After median follow-up time of 25 months, 7/20 patients (33%) developed late AMR.
ABMR is a serious early complication after KT. Early detection and intensive treatment is mandatory for salvaging the graft. After surpassing from early AMR, long-term close monitoring is also necessary.
急性抗体介导的排斥反应（AMR）是早期肾移植功能障碍的主要原因。本研究旨在探讨本中心早期AMR的临床病理特征及长期预后。
我们回顾性分析了2005年1月至2012年12月期间接受肾移植的所有患者。纳入移植后3个月内具有AMR组织病理学特征的患者。
444例患者中，25例（5.36%）被诊断为早期急性AMR。17例（68%）患者高度致敏。组织学分析显示，21例（84%）患者出现急性血管排斥反应，6例（24%）患者出现血栓性微血管病。20例患者中有6例（12%）检测到肾小管周围毛细血管C4d染色。所有患者均接受1.5个血容量的血浆置换（PE），共1 - 5次，随后静脉注射免疫球蛋白（IVIG）2 g/kg。16例（64%）患者接受1 - 2剂利妥昔单抗375 mg/m²。难治性病例我们重复使用PE和IVIG治疗。20例患者（80%）的移植肾得以挽救，而5例（20%）患者移植肾丢失。Kaplan-Meier生存分析显示，与无早期AMR的患者相比，早期AMR组的累积移植肾生存率较低（1年生存率分别为80%对96%，3年生存率分别为64%对80%；P < 0.001）。中位随访时间25个月后，20例患者中有7例（33%）发生晚期AMR。
ABMR是肾移植术后严重的早期并发症。早期检测和强化治疗对于挽救移植肾至关重要。度过早期AMR后，长期密切监测也很有必要。
