Gigliotti Paolo, Lofaro Danilo, Leone Francesca, Papalia Teresa, Senatore Massimino, Greco Rosita, Perri Anna, Vizza Donatella, Lupinacci Simona, Toteda Giuseppina, La Russa Antonella, De Stefano Roberto, Romeo Francesco, Bonofiglio Renzo
"Kidney and Transplantation" Research Center, Department of Nephrology, Dialysis and Transplantation, Annunziata Hospital, via F. Migliori, 87100, Cosenza, Italy.
Department of Anatomic Pathology, Annunziata Hospital, Cosenza, Italy.
J Nephrol. 2016 Jun;29(3):443-449. doi: 10.1007/s40620-015-0206-0. Epub 2015 May 13.
Subclinical rejection (SCR) has been variably associated with reduced graft survival, development and progression of interstitial fibrosis/tubular atrophy and chronic allograft nephropathy, but data are controversial concerning SCR treatment in terms of graft survival improvement. In this single-center retrospective study, we enrolled 174 adult kidney transplant recipients with a protocol biopsy performed at 30 days after transplantation to evaluate the incidence rate and risk factors for early SCR and its impact on 10-year graft survival. Five patients showed primary non function and were excluded. Among 159/169 (94.08 %) patients with stable graft function who underwent protocol biopsy, 17 (10.7 %) showed signs of SCR and were treated with low-dose intravenous (i.v.) steroids. Ten patients showed functional impairment, 8 (4.73 %) resulting as acute rejection. At multivariate analysis, donor age [odds ratio (OR) 1.04, 95 % confidence interval (CI) 1.01-1.09], and delayed graft function (DGF) (OR 1.08, 95 % CI 1.03-1.12) were significantly associated with SCR. The 10-year graft survival rate in the SCR group was similar to that in the normal-findings group (76.5 vs. 74.9 % respectively; p = 0.61). At multivariate Cox regression, acute [hazard ratio (HR) 5.22, 95 % CI 1.70-16.01], but not sub-clinical, rejection was independently associated with long-term graft failure. In conclusion, early protocol biopsy is a useful and safe tool to detect early SCR which seems not to affect the long-term survival. We suggest that this could be, probably, linked to early SCR treatment with low dose i.v. steroids.
亚临床排斥反应（SCR）与移植肾存活期缩短、间质纤维化/肾小管萎缩及慢性移植肾肾病的发生和进展存在不同程度的关联，但关于SCR治疗能否改善移植肾存活的数据存在争议。在这项单中心回顾性研究中，我们纳入了174例成年肾移植受者，这些受者在移植后30天接受了方案活检，以评估早期SCR的发生率、危险因素及其对10年移植肾存活的影响。5例患者出现原发性无功能，被排除在外。在159/169例（94.08%）移植肾功能稳定且接受方案活检的患者中，17例（10.7%）表现出SCR迹象，并接受了小剂量静脉注射类固醇治疗。10例患者出现功能损害，其中8例（4.73%）为急性排斥反应。多因素分析显示，供体年龄[比值比（OR）1.04，95%置信区间（CI）1.01 - 1.09]和移植肾功能延迟恢复（DGF）（OR 1.08，95% CI 1.03 - 1.12）与SCR显著相关。SCR组的10年移植肾存活率与检查结果正常组相似（分别为76.5%和74.9%；p = 0.61）。多因素Cox回归分析显示，急性排斥反应[风险比（HR）5.22，95% CI 1.70 - 16.01]而非亚临床排斥反应与长期移植肾失功独立相关。总之，早期方案活检是检测早期SCR的一种有用且安全的工具，早期SCR似乎不影响长期存活。我们认为，这可能与早期使用小剂量静脉注射类固醇治疗SCR有关。
