Krisl Jill C, Alloway Rita R, Shield Adele Rike, Govil Amit, Mogilishetty Gautham, Cardi Michael, Diwan Tayyab, Abu Jawdeh Bassam G, Girnita Alin, Witte David, Woodle E Steve
1 Houston Methodist Hospital, Houston, TX. 2 Division of Transplantation, Department of Surgery, University of Cincinnati Academic Health Center, Cincinnati, OH. 3 University of Cincinnati Medical Center, Cincinnati, OH. 4 The Christ Hospital, Cincinnati, OH. 5 Kidney and Hypertension Center, The Christ Hospital, Cincinnati, OH.
Transplantation. 2015 Oct;99(10):2167-73. doi: 10.1097/TP.0000000000000706.
Classification of acute rejection (AR) based on etiology and timing may provide a means for enhancing therapeutic results and allograft survival. This study evaluated graft and patient survival after the first AR episodes among kidney transplant recipients with an early or late antibody-mediated rejection (AMR), acute cellular rejection (ACR) or mixed AR (MAR).
A prospective institutional review board-approved database was queried to identify biopsy-proven first AR episodes occurring from January 2005 to October 2012. The ACR was defined by Banff criteria; borderline AR was excluded. The AMR was defined as 3 of 4 criteria: renal dysfunction, donor specific antibody, C4d positivity on biopsy, and histological changes. The MAR met criteria for both ACR and AMR. Early AR occurred within six months post-transplant. AR episodes were then assigned to 1 of the 6 categories--early AMR, early ACR, early MAR, late AMR, late ACR, and late MAR.
One hundred eighty-two kidney transplant recipients identified with a first AR episode. Mean follow-up was 773 days (± 715 days). No difference was observed in patient survival. Death-censored graft survival was 84%. Death-censored graft loss was higher with late versus early AMR (P = 0.01) and late versus early ACR (P = 0.03), but not late versus early MAR (P = 0.3).
The AR type demonstrated a hierarchy for graft survival with ACR better than MAR better than AMR, which persisted for both early and late AR. Improvement in long-term results of AR may require development of specific treatment for individual AR types.
基于病因和时间对急性排斥反应（AR）进行分类，可能为提高治疗效果和同种异体移植物存活率提供一种方法。本研究评估了早期或晚期抗体介导的排斥反应（AMR）、急性细胞排斥反应（ACR）或混合性AR（MAR）的肾移植受者首次AR发作后的移植物和患者存活率。
查询前瞻性机构审查委员会批准的数据库，以确定2005年1月至2012年10月间经活检证实的首次AR发作。ACR由班夫标准定义；排除临界AR。AMR定义为以下4项标准中的3项：肾功能障碍、供体特异性抗体、活检时C4d阳性和组织学改变。MAR符合ACR和AMR的标准。早期AR发生在移植后6个月内。然后将AR发作分为6类中的1类——早期AMR、早期ACR、早期MAR、晚期AMR、晚期ACR和晚期MAR。
182例肾移植受者被确定为首次AR发作。平均随访时间为773天（±715天）。患者存活率未观察到差异。死亡截尾移植物存活率为84%。晚期AMR与早期AMR相比（P = 0.01）以及晚期ACR与早期ACR相比（P = 0.03），死亡截尾移植物丢失率更高，但晚期MAR与早期MAR相比（P = 0.3）则不然。
AR类型在移植物存活方面表现出一种层次结构，ACR优于MAR优于AMR，这在早期和晚期AR中均持续存在。AR长期结果的改善可能需要针对个体AR类型开发特异性治疗方法。
