Monteverde Marta Lidia, Chaparro Alicia, Goldberg Julio, Marcos Cintia Yanina, Padros Karim, Balbarrey Ziomara, Briones Liliana, Rush David
Department of Nephrology, Hospital JP. Garrahan, Buenos Aires, Argentina.
Department of Pathology, Hospital JP. Garrahan, Buenos Aires, Argentina.
Pediatr Transplant. 2015 Nov;19(7):684-90. doi: 10.1111/petr.12556. Epub 2015 Jul 24.
Donor-specific anti-HLA antibodies (DSA) causing CAMR are responsible for a high proportion of long-term graft failures after RTX. We studied the prevalence of DSA in RTX children biopsied for creeping Cr, its relationship with NA, and patient and graft survival according to histopathology. Between 2008 and 2013, 92 children were biopsied at a median of 38 months post-RTX. At biopsy, the prevalence of DSA was 49% and C4d 70%. NA rate was 45%, higher in adolescents (60%). Most frequent diagnoses were CAMR (72%) and interstitial fibrosis with tubular atrophy (IFTA) (28%). Forty-five of 66 patients with CAMR (68%) had detectable DSA. Twenty-one DSA-negative patients with CAMR had histological damage (IFTA + C4d positivity). C4d was detected in 64 of 66 biopsies with CAMR. Recipients with IFTA alone had neither C4d, nor detectable DSA, and were adherent. Graft survival at five yr was 89% in patients with CAMR, 79% in those with CAMR + TCMR Banff I, 33% in those with CAMR + TCMR Banff II, and 96% in those with IFTA. ABMR and complement activation were frequent in children biopsied for creeping Cr. Recipients with DSA were more likely to be non-adherent and have CAMR or CAMR + TCMR and worse graft survival.
导致CAMR的供者特异性抗HLA抗体（DSA）是RTX后长期移植物失败的主要原因。我们研究了因慢性移植物肾病而接受活检的RTX儿童中DSA的患病率、其与NA的关系以及根据组织病理学的患者和移植物存活率。2008年至2013年期间，92名儿童在RTX后中位38个月时接受了活检。活检时，DSA的患病率为49%，C4d为70%。NA率为45%，青少年中更高（60%）。最常见的诊断是CAMR（72%）和间质纤维化伴肾小管萎缩（IFTA）（28%）。66例CAMR患者中有45例（68%）可检测到DSA。21例DSA阴性的CAMR患者有组织学损伤（IFTA + C4d阳性）。66例CAMR活检中有64例检测到C4d。仅患有IFTA的受者既没有C4d，也没有可检测到的DSA，并且依从性良好。CAMR患者5年移植物存活率为89%，CAMR + TCMR Banff I患者为79%，CAMR + TCMR Banff II患者为33%，IFTA患者为96%。因慢性移植物肾病接受活检的儿童中ABMR和补体激活很常见。有DSA的受者更有可能不依从，患有CAMR或CAMR + TCMR，并且移植物存活率更差。
