Arnol Miha, Oblak Manca, Mlinšek Gregor, Lindič Jelka, Kandus Aljoša, Ferluga Dušan, Kojc Nika, Buturović-Ponikvar Jadranka
Clin Nephrol. 2017;88(13):83-90. doi: 10.5414/CNP88FX20.
A noninvasive test that foretells kidney graft rejection before loss of kidney function would be desirable. We hypothesized that an increase in estimated protein excretion rate (ePER) from spot urine samples is associated with graft rejection and predicts rejection phenotype.
151 patients who had undergone first-indication kidney biopsy due to graft dysfunction beyond 3 months after transplant were identified from a national cohort of 616 transplant recipients between 2000 and 2012 (25%). ePER were calculated from spot urine protein-to-creatinine ratios at baseline, 3 months before biopsy (ePER), and at the time of biopsy (ePER) and were correlated with histologic biopsy findings.
Levels of ePER 3 months before biopsy and at the time of biopsy were greater in 32 patients with antibody-mediated rejection (ABMR) than in 77 patients with T-cell-mediated rejection (TCMR) and 42 patients with other findings (median ePER 912 vs. 320 vs. 232 mg/day/1.73m; and median ePER 1,672 vs. 356 vs. 268 mg/day/1.73m; p < 0.001). Receiver operator characteristics (ROC) analyses demonstrated that ePER and ePER had good diagnostic accuracy to discriminate between biopsy specimens showing ABMR vs. those showing TCMR or other histologic findings (area under the ROC curve 0.84, 95% CI 0.75 - 0.93 and 0.89, 95% CI 0.82 - 0.97, respectively; p < 0.001).
CONCLUSIONS: An increase in ePER before kidney graft dysfunction appears to be associated with graft rejection and predicts ABMR phenotype. .
一种能在肾功能丧失前预测肾移植排斥反应的非侵入性检测方法将很有必要。我们假设，即时尿样中估计蛋白排泄率（ePER）的增加与移植排斥反应相关，并能预测排斥反应表型。
从2000年至2012年全国616名移植受者队列中确定了151名患者，这些患者因移植后3个月以上出现移植功能障碍而接受首次指征肾活检（占25%）。根据即时尿样中基线、活检前3个月（ePER）和活检时（ePER）的尿蛋白与肌酐比值计算ePER，并将其与组织学活检结果相关联。
32例抗体介导排斥反应（ABMR）患者活检前3个月和活检时的ePER水平高于77例T细胞介导排斥反应（TCMR）患者和42例其他结果患者（ePER中位数分别为912 vs. 320 vs. 232mg/天/1.73m²；ePER中位数分别为1672 vs. 356 vs. 268mg/天/1.73m²；p<0.001）。受试者操作特征（ROC）分析表明，ePER和ePER在区分显示ABMR的活检标本与显示TCMR或其他组织学结果的活检标本方面具有良好的诊断准确性（ROC曲线下面积分别为0.84，95%CI 0.75 - 0.93和0.89，95%CI 0.82 - 0.97；p<0.001）。
肾移植功能障碍前ePER的增加似乎与移植排斥反应相关，并能预测ABMR表型。
