Sui Yanxia, Sun Tao, Zhao Dongli, Hou Jun, Li Xiaofeng, Yang Zhe
Department of Pathology, First Affiliated Hospital, Department of Oncology, Department of Kidney Transplant, Xi'an Jiaotong University College of Medicine, Xi'an 710061, China. E-mail:
Nan Fang Yi Ke Da Xue Xue Bao. 2014 Mar;34(3):341-4.
To investigate the pathological and immunological changes of renal grafts in recipients experiencing graft rejection.
The clinicopathologic data of 56 renal needle biopsy samples obtained from renal transplant recipients were analyzed retrospectively. The specimens were classified histopathologically according to the Banff 2009 classification system and analyzed by immunohistochemical labeling and immunofluorescence.
In the 56 recipients, 1 (1.79%) experienced hyperacute rejection, 8 (14.29%) had suspected acute rejection, 12 (21.43%) developed acute T-cell rejection, 6 (10.71%) had acute antibody-mediated rejection, 2 (3.57%) had acute T-cell rejection with acute antibody-mediated rejection, 12 (21.43%) had chronic active T cell-mediated rejection, 2 (3.57%) had chronic active antibody-mediated rejection, 2 (3.57%) had chronic active T cell-mediated rejection with antibody-mediated rejection, 8 (14.29%) had non-specific interstitial fibrosis and tubular atrophy, and 3 (5.36%) had normal graft function. The expression levels of immune markers CD3, CD4, CD8, CD20, GrB and perforin differed with the types of T cell-mediated graft rejection, and the positivity and expression levels of these markers tended to increased with the severity of graft rejection. The expression of C4d was positive in all cases with antibody-mediated graft rejection.
The pathological characteristics of the renal biopsy specimens and expression levels of the immune markers allow timely and accurate evaluation of graft rejection type to provide a reliable pathological and etiological basis for clinical treatment and prognostic assessment.
研究发生移植肾排斥反应的受者移植肾的病理及免疫变化。
回顾性分析56例肾移植受者肾穿刺活检标本的临床病理资料。标本根据2009年Banff分类系统进行组织病理学分类，并通过免疫组织化学标记和免疫荧光分析。
56例受者中，1例（1.79%）发生超急性排斥反应，8例（14.29%）疑似急性排斥反应，12例（21.43%）发生急性T细胞排斥反应，6例（10.71%）发生急性抗体介导的排斥反应，2例（3.57%）发生急性T细胞排斥反应合并急性抗体介导的排斥反应，12例（21.43%）发生慢性活动性T细胞介导的排斥反应，2例（3.57%）发生慢性活动性抗体介导的排斥反应，2例（3.57%）发生慢性活动性T细胞介导的排斥反应合并抗体介导的排斥反应，8例（14.29%）发生非特异性间质纤维化和肾小管萎缩，3例（5.36%）移植肾功能正常。免疫标志物CD3、CD4、CD8、CD20、颗粒酶B和穿孔素的表达水平随T细胞介导的移植排斥反应类型不同而有所差异，且这些标志物的阳性率和表达水平随移植排斥反应严重程度增加而呈上升趋势。在所有抗体介导的移植排斥反应病例中，C4d表达均为阳性。
肾活检标本的病理特征及免疫标志物表达水平有助于及时、准确评估移植排斥反应类型，为临床治疗及预后评估提供可靠的病理及病因学依据。
