1 Division of Transplantation Surgery, Mayo Clinic, Rochester, MN. 2 Renal Institute of Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom. 3 Department of Anatomic Pathology, Mayo Clinic, Rochester, MN. 4 Division of Transfusion Medicine, Mayo Clinic, Rochester, MN. 5 Address correspondence to: Mark D. Stegall, M.D., Division of Transplantation Surgery and von Liebig Transplant Center, Mayo Clinic, Rochester, MN, U.S.A., Mayo Clinic, 200 First Street, SW Rochester, MN 55905.
Transplantation. 2014 Nov 27;98(10):1089-96. doi: 10.1097/TP.0000000000000188.
ABO-incompatible kidney transplantations (ABOiKTxs) seem to have better long-term outcomes than positive crossmatch kidney transplantations (+XMKTxs).
This study aimed to assess the differences in chronic injury on histologic findings on 1- and 5-year surveillance biopsies and the clinical outcomes in living-donor kidney transplantations performed between May 1999 and November 2006 including 102 +XMKTxs, 73 ABOiKTxs, and 652 conventional KTxs.
Although 5-year patient survival was similar between groups, graft loss between 1 and 5 years was similar in ABOiKTx (2.6% per year) and conventional KTx (1.7% per yr), and both were lower than that of +XMKTx (5.8% per year). At 5 years, renal function was similar in ABOiKTx and conventional KTx, and both were higher than that of +XMKTx, which had higher rates of inflammation and chronic glomerulopathy on both 1- and 5-year biopsies. Despite having evidence of less chronic injury, ABOiKTx showed a higher rate of intragraft complement activation (C4d deposition) at 5 years compared with +XMKTx (77.8% vs. 18.9%, P<0.001).
These data suggest that +XMKTxs have high rates of chronic inflammation at 1 and 5 years after transplantation, which may explain the higher rates of graft loss and lower renal function compared with other factors such as anti-donor antibody or intragraft complement deposition.
ABO 不相容肾移植（ABOiKTxs）似乎比正交叉配型肾移植（+XMKTxs）具有更好的长期结果。
本研究旨在评估在 1999 年 5 月至 2006 年 11 月期间进行的活体供肾移植中，1 年和 5 年随访活检的组织学发现中的慢性损伤差异以及临床结果，包括 102 例+XMKTxs、73 例 ABOiKTxs 和 652 例常规 KTx。
尽管各组患者 5 年生存率相似，但 ABOiKTx（每年 2.6%）和常规 KTx（每年 1.7%）在 1 至 5 年内的移植物丢失率相似，均低于+XMKTx（每年 5.8%）。在 5 年时，ABOiKTx 和常规 KTx 的肾功能相似，均高于+XMKTx，后者在 1 年和 5 年活检中均显示出更高的炎症和慢性肾小球病变发生率。尽管有证据表明慢性损伤较轻，但与+XMKTx 相比，ABOiKTx 在 5 年内移植肾内补体激活（C4d 沉积）的发生率更高（77.8%比 18.9%，P<0.001）。
这些数据表明，+XMKTxs 在移植后 1 年和 5 年时有较高的慢性炎症发生率，这可能解释了与其他因素（如抗供体抗体或移植肾内补体沉积）相比，+XMKTxs 更高的移植物丢失率和较低的肾功能。
