抗血管紧张素II 1型受体抗体阳性、发生急性排斥且无供体特异性HLA抗体的肾移植受者的组织病理学变化

Histopathologic changes in anti-angiotensin II type 1 receptor antibody-positive kidney transplant recipients with acute rejection and no donor specific HLA antibodies.

作者信息

Lim Mary Ann, Palmer Matthew, Trofe-Clark Jennifer, Bloom Roy D, Jackson Annette, Philogene Mary Carmelle, Kamoun Malek

机构信息

Department of Medicine, Renal Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.

Department of Pathology and Laboratory Medicine, Perelman School of Medicine, Philadelphia, PA, United States.

出版信息

Hum Immunol. 2017 Apr;78(4):350-356. doi: 10.1016/j.humimm.2017.03.004. Epub 2017 Mar 8.

DOI:10.1016/j.humimm.2017.03.004

PMID:28284829

Abstract

OBJECTIVE

To determine the association of antibodies against angiotensin II type 1 receptor (AT1R Ab) and histopathologic changes seen in patients with kidney allograft rejection and negative donor specific HLA antibodies (DSA).

METHODS

Stored sera from 27 patients who had biopsy-proven rejection in the absence of DSA were tested for AT1R Ab. Biopsy slides of all patients were re-examined and classified according to Banff 2013 criteria. Histopathologic changes were compared between AT1R positive and negative patients.

RESULTS

75% of patients with positive pre-transplant AT1R Ab had antibody mediated rejection (AMR) compared to 37% of AT1R Ab-negative patients. A trend towards increased interstitial inflammation was observed in the AT1R Ab positive group (p=0.08). More patients in the AT1R Ab positive group had microcirculation inflammation (88% vs 58% with glomerulitis scores ≥1; 75% vs 58% with peritubular capillaritis scores ≥1).

CONCLUSION

In kidney transplant recipients with rejection and no DSA, a higher incidence of AMR and worse inflammation scores are observed in the presence of positive pre-transplant AT1R antibodies.

摘要

目的

确定肾移植受者发生排斥反应且供者特异性 HLA 抗体（DSA）阴性时，抗血管紧张素 II 1 型受体抗体（AT1R Ab）与组织病理学变化之间的关联。

方法

对 27 例经活检证实存在排斥反应且无 DSA 的患者的储存血清进行 AT1R Ab 检测。重新检查所有患者的活检切片，并根据 2013 年 Banff 标准进行分类。比较 AT1R 阳性和阴性患者的组织病理学变化。

结果

移植前 AT1R Ab 阳性的患者中，75%发生了抗体介导的排斥反应（AMR），而 AT1R Ab 阴性患者中这一比例为 37%。在 AT1R Ab 阳性组中观察到间质炎症有增加的趋势（p = 0.08）。AT1R Ab 阳性组中更多患者存在微循环炎症（肾小球炎评分≥1时为 88%对 58%；肾小管周围毛细血管炎评分≥1时为 75%对 58%）。