Shimizu T, Ishida H, Hayakawa N, Shibahara R, Tanabe K
Department of Transplant Surgery, Toda Chuo General Hospital, Saitama, Japan; Department of Urology, Toda Chuo General Hospital, Saitama, Japan; Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.
Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.
Transplant Proc. 2017 Dec;49(10):2251-2255. doi: 10.1016/j.transproceed.2017.09.046.
We performed a clinical and pathological analysis of cases of acute vascular rejection (AVR), characterized by intimal arteritis and transmural arteritis (Banff v score) after kidney transplantation, in an attempt to clarify the mechanisms underlying the development and prognostic significance of AVR.
AVR (Banff score: v >0) was diagnosed in 31 renal allograft biopsy specimens (BS) obtained from 31 renal transplant patients receiving follow-up care at the Department of Urology, Tokyo Women's Medical University, between January 2010 and April 2016.
AVR was diagnosed at a median of 124.6 days after transplantation. Among the 31 BS showing evidence of AVR, AVR was mild (v1 in Banff's classification) in 25 cases, moderate (v2) in 6, and severe (v3) in none. We classified the 31 BS with evidence of AVR by their overall histopathological features as follows: isolated v lesions were observed in 6 BS, acute antibody-mediated rejection (AAMR) in 7, acute T-cell-mediated rejection (ATCMR) in 12, and both ATCR and AAMR in 6. Loss of the renal allograft occurred during the observation period in 3 patients, and, of the remaining cases with functioning grafts, deterioration of renal allograft function after biopsy occurred in only 2 patients.
The results of our study suggest that ATCMR contributes to AVR in 40% to 60% of cases, AAMR in 20% to 40% of cases, and isolated v lesions in 20% of cases. The prognosis of the patient with the graft that had AVR was relatively good under the present immunosuppression protocol and current anti-rejection therapies.
我们对肾移植后以内膜动脉炎和透壁动脉炎为特征（班夫v级评分）的急性血管排斥反应（AVR）病例进行了临床和病理分析，以阐明AVR发生发展的机制及其预后意义。
2010年1月至2016年4月期间，在东京女子医科大学泌尿外科接受随访的31例肾移植患者的31份肾移植活检标本（BS）中诊断出AVR（班夫评分：v>0）。
AVR在移植后中位124.6天被诊断出来。在31份显示AVR证据的BS中，25例为轻度AVR（班夫分类中的v1级），6例为中度（v2级），无重度（v3级）。我们根据其总体组织病理学特征将31份有AVR证据的BS分类如下：6份BS中观察到孤立的v病变，7份为急性抗体介导的排斥反应（AAMR），12份为急性T细胞介导的排斥反应（ATCMR），6份同时存在ATCR和AAMR。观察期间有3例患者的肾移植丢失，在其余移植肾功能良好的病例中，活检后只有2例患者的移植肾功能恶化。
我们的研究结果表明，40%至60%的病例中ATCMR导致AVR，20%至40%的病例中AAMR导致AVR，20%的病例中为孤立的v病变。在目前的免疫抑制方案和当前的抗排斥治疗下，发生AVR的移植患者的预后相对较好。
