Akagun Tulin, Yazici Halil, Caliskan Yasar, Ozluk Yasemin, Sahin Sevgi, Turkmen Aydin, Kılıcaslan Isın, Sever Mehmet Sukru
a Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine , Istanbul University , Istanbul , Turkey.
b Department of Pathology, Istanbul Faculty of Medicine , Istanbul University , Istanbul , Turkey.
Ren Fail. 2017 Nov;39(1):19-25. doi: 10.1080/0886022X.2016.1244073. Epub 2016 Oct 24.
Antibody-mediated rejection is a frequent cause of graft failure; however, prognostic indications of this complication have not been well defined. The aim of this study was to evaluate the association of histopathological and clinical features and to determine the effect of these findings on allograft survival in patients with AMR.
Fifty-two patients suffered from AMR (30 male; mean age 39 ± 11 years) were included in the study. Data were investigated retrospectively and graft survival was analyzed. All transplant biopsies were evaluated according to Banff 2009 classification.
Of the 52 cases, 45 were transplanted from living-donors. Twenty-one patients were diagnosed in the first 3-months after transplantation. Graft survival was 65% at 12 months and 54% at 36 months. Mean serum creatinine at time of biopsy was 3.8 ± 3.6 mg/dL. Thirty-five of the 52 cases showed diffuse C4d positivity, 12 cases showed focal and 5 remained C4d negative. One of the patients died, 13 experienced graft loss and 38 survived with functioning grafts. Serum creatinine levels at time of biopsy were correlated with graft survival (p = .021: OR = 1.10: 95 % CI = 1.015-1.199). In terms of the impact of pathological findings; tubulitis (p=.007: OR = 2.62: 95 % CI = 1.301-5.276), intimal arteritis (p=.017: OR = 2.85: 95% CI = 1.205-6.744) and interstitial infiltration (p=.004: OR = 3.37: 95% CI = 1.465-7.752) were associated with graft survival.
Serum creatinine at time of biopsy, tubulitis, intimal arteritis and interstitial infiltration were significantly associated with graft survival. Antibody-mediated rejection is associated with reduced long-term graft survival.
抗体介导的排斥反应是移植失败的常见原因；然而，这种并发症的预后指标尚未明确界定。本研究的目的是评估组织病理学和临床特征之间的关联，并确定这些发现对抗体介导排斥反应患者同种异体移植物存活的影响。
本研究纳入了52例抗体介导排斥反应患者（30例男性；平均年龄39±11岁）。对数据进行回顾性调查并分析移植物存活情况。所有移植活检均根据2009年班夫分类法进行评估。
52例患者中，45例接受活体供体移植。21例患者在移植后的前3个月被诊断出来。12个月时移植物存活率为65%，36个月时为54%。活检时的平均血清肌酐为3.8±3.6mg/dL。52例患者中有35例显示弥漫性C4d阳性，12例显示局灶性阳性，5例C4d阴性。1例患者死亡，13例出现移植物丢失，38例移植物功能良好存活。活检时的血清肌酐水平与移植物存活相关（p = 0.021：OR = 1.10：95%CI = 1.015 - 1.199）。就病理结果的影响而言，肾小管炎（p = 0.007：OR = 2.62：95%CI = 1.301 - 5.276）、内膜动脉炎（p = 0.017：OR = 2.85：95%CI =
