Mubarak Muhammed, Abbas Khawar, Zafar Mirza Naqi, Aziz Tahir
From the Departments of Histopathology, Immunology, Clinical Chemistry, and Nephrology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
Exp Clin Transplant. 2017 Oct;15(5):516-520. doi: 10.6002/ect.2016.0188. Epub 2017 May 3.
Our aim was to analyze the immunohistopathologic features of plasma cell-rich acute rejection in a living-related renal transplant setting.
Renal allograft biopsies of 50 cases of plasma cell-rich acute rejection were reviewed, and the main immunohistopathologic features were analyzed. The biopsies were studied using light microscopy, immunofluorescence, and immunohistochemistry and reported according to Banff classification. Biopsy findings were correlated with graft function and outcome.
From February 2012 to December 2013, 50/1630 (3%) dysfunctional renal allograft biopsies showed plasma cell-rich acute rejection. Among acute changes, interstitial inflammation was of moderate degree in 8 cases (16%) and severe in 42 cases (84%). Mild tubulitis was found in 4 cases (8%), moderate tubulitis in 8 cases (16%), and severe tubulitis in 38 cases (76%). Glomerulitis was found in 2 cases (4%). No presence of arteritis was found. All plasma cell-rich acute rejection cases were of tubulointerstitial type, and most were of type IB. The mean percent of plasma cells on light microscopy in all cases was 28.8 ± 11.7%, and the range was 10% to 60%, with 46 cases (92%) showing plasma cell percent of ≥ 20%. The mean plasma cell percent on immunohistochemistry for CD138 was 29.0 ± 12.4%. Microvascular inflammation was found in 34 cases (68%). C4d testing was done by immunofluorescence in 22 cases (44%) and was positive in 8 cases (36%). Interstitial fibrosis/tubular atrophy was mild in 18 (36%), moderate in 28 (56%), and severe in 4 cases (8%). Plasma cell enrichment did not correlate with a variety of clinical and pathologic features (all P > .05).
Plasma cell enrichment is not an independent prognostic morphologic feature and may represent either T-cell-mediated or antibody-mediated rejection or a mixture of these processes. Further investigations regarding its pathogenesis, accurate categorization, and treatment are needed.
我们的目的是分析亲属活体肾移植中富含浆细胞的急性排斥反应的免疫组织病理学特征。
回顾了50例富含浆细胞的急性排斥反应的同种异体肾移植活检标本，并分析其主要免疫组织病理学特征。活检标本采用光学显微镜、免疫荧光和免疫组织化学方法进行研究，并根据Banff分类法报告。将活检结果与移植肾功能及预后相关联。
2012年2月至2013年12月，1630例功能异常的同种异体肾移植活检标本中有50例（3%）显示为富含浆细胞的急性排斥反应。在急性改变中，8例（16%）间质炎症为中度，42例（84%）为重度。4例（8%）发现轻度肾小管炎，8例（16%）为中度肾小管炎，38例（76%）为重度肾小管炎。2例（4%）发现肾小球炎。未发现动脉炎。所有富含浆细胞的急性排斥反应病例均为肾小管间质型，且大多数为IB型。所有病例光学显微镜下浆细胞的平均百分比为28.8±11.7%，范围为10%至60%，46例（92%）浆细胞百分比≥20%。CD138免疫组织化学检测浆细胞的平均百分比为29.0±12.4%。34例（68%）发现微血管炎症。22例（44%）通过免疫荧光进行C4d检测，8例（36%）呈阳性。18例（36%）间质纤维化/肾小管萎缩为轻度，28例（56%）为中度，4例（8%）为重度。浆细胞富集与多种临床和病理特征均无相关性（所有P>.05）。
浆细胞富集不是一个独立的预后形态学特征，可能代表T细胞介导的排斥反应、抗体介导的排斥反应或这些过程的混合。需要对其发病机制、准确分类和治疗进行进一步研究。
