Genina Ashraf, Ismail Wesam, Soliman Amin Roshdy
Internal Medicine Department, BeniSuef University, Cairo, Egypt.
Pathology Department, BeniSuef University, Cairo, Egypt.
Arab J Nephrol Transplant. 2014 May;7(2):97-101.
The recognition of antibody mediated rejection has led to re-appreciation of the role of B cells in acute and chronic allograft rejection. The presence of CD20 positive lymphocytic infiltrates in acute cellular rejection has been associated with poor clinical outcomes and reduced graft survival. Recently molecular gene analysis has shown that grafts with antibody-mediated rejection (ABMR) have lower expression of CD20.
We reviewed 28 renal allograft biopsies, including 13 biopsies from patients who experienced acute ABMR and a matched group of 15 patients with acute T cell mediated rejection (TCMR) to serve as controls. All biopsies were stained by anti-CD20 and anti-CD8 antibodies.
All twenty-eight biopsies were found to have CD20 positive cells within their interstitial infiltrate. The distribution of CD20 positive cells varied from sparse cells to small or dense clusters in the interstitium. We found no statistically significant differences in CD20 or CD8 cell counts between the ABMR and TCMR groups. We noticed a weak positive correlation between the numbers of CD20 positive cells and the grade/severity of rejection but it didn't reach statistical significance (r=0.37, p=0.06). However, we found a significant positive correlation between the number of CD20 positive cells and intimal artertitis score (r=0.39, p < 0.05).
Our findings suggest that there is a possible relation between the presence of CD20 positive lymphocytic infiltrates and a more severe histological form of rejection. However, we failed to establish a relationship between their actual presence in the interstitial infiltrate and distinct mechanisms of graft rejection.
对抗体介导的排斥反应的认识促使人们重新认识B细胞在急性和慢性同种异体移植排斥反应中的作用。急性细胞排斥反应中CD20阳性淋巴细胞浸润的存在与不良临床结局及移植肾存活率降低有关。最近的分子基因分析表明，发生抗体介导的排斥反应（ABMR）的移植肾CD20表达较低。
我们回顾了28例肾移植活检病例，其中包括13例经历急性ABMR患者的活检标本，以及15例急性T细胞介导的排斥反应（TCMR）患者作为匹配对照组。所有活检标本均用抗CD20和抗CD8抗体染色。
所有28例活检标本均在间质浸润中发现有CD20阳性细胞。CD20阳性细胞的分布在间质中从稀疏细胞到小簇或密集簇不等。我们发现ABMR组和TCMR组之间CD20或CD8细胞计数无统计学显著差异。我们注意到CD20阳性细胞数量与排斥反应分级/严重程度之间存在弱正相关，但未达到统计学显著性（r = 0.37，p = 0.06）。然而，我们发现CD20阳性细胞数量与内膜动脉炎评分之间存在显著正相关（r = 0.39，p < 0.05）。
我们的研究结果表明，CD20阳性淋巴细胞浸润的存在与更严重的组织学排斥反应形式之间可能存在关联。然而，我们未能在间质浸润中它们的实际存在与移植排斥反应的不同机制之间建立联系。
