现行与既往诊断阈值对指示性活检诊断为 T 细胞介导排斥边缘性改变患者结局的影响。

Impact of the Current Versus the Previous Diagnostic Threshold on the Outcome of Patients With Borderline Changes Suspicious for T Cell-mediated Rejection Diagnosed on Indication Biopsies.

机构信息

Transplantation Unit, Renal Division, Department of Medicine, University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, QC, Canada.

Department of Pathology, University Health Center of Quebec, Faculty of Medicine, Laval University, Québec, QC, Canada.

出版信息

Transplantation. 2018 Dec;102(12):2120-2125. doi: 10.1097/TP.0000000000002327.

DOI:10.1097/TP.0000000000002327

PMID:29916985

Abstract

BACKGROUND

Since the borderline changes suspicious for acute T cell-mediated rejection (BL) category was broadened, there has been a debate regarding the right threshold for tubulitis and interstitial inflammation scores.

METHODS

We studied a first cohort of 111 patients with BL found on an indication biopsy between 2006 and 2016 and compared those with scores of t1i0 (BLt1i0) to those with higher scores (BL≥t1i1). A second cohort of 56 patients with BL was used for external validation. We used a composite endpoint of death-censored graft failure or doubling of the serum creatinine level postbiopsy.

RESULTS

In the first cohort, 68% (75/111) of the BL cases fell in the BLt1i0 group. At 5 years, the occurrence of the composite endpoint was 5% and 14% for BLt1i0 and BL≥t1i1, respectively. In contrast, the endpoint occurred in 5% of nonrejectors and 21% of patients with T cell-mediated rejection. In the validation cohort, 8% versus 36% of BLt1i0 and BL≥t1i1 reached the endpoint, respectively. Multivariable Cox modeling revealed that BLt1i0 patients had a prognosis similar to that of nonrejectors (adjusted hazard ratio, 0.6; 95% confidence interval, 0.1-2.2; P = 0.40) but better than that of patients with BL≥t1i1 (hazard ratio, 3.8; 95% confidence interval, 1.3-11.5; P = 0.02). Sensitivity analyses restricted to death-censored graft loss or using time posttransplant as the time of reference provided similar results.

CONCLUSIONS

In summary, patients with BLt1i0 have a different prognosis to that of BL≥t1i1 patients, which brings into question the current diagnostic thresholds.

摘要

背景

自从可疑急性 T 细胞介导排斥反应（BL）的边界变化类别扩大以来，关于 tubulitis 和间质炎症评分的正确阈值一直存在争议。

方法

我们研究了 2006 年至 2016 年间因指示性活检发现的 BL 的第一队列 111 例患者，并将 t1i0 评分（BLt1i0）与更高评分（BL≥t1i1）的患者进行比较。使用 BL 的第二队列 56 例患者进行外部验证。我们使用活检后死亡相关移植物失败或血清肌酐水平加倍的复合终点。

结果

在第一队列中，68%（75/111）的 BL 病例属于 BLt1i0 组。在 5 年内，BLt1i0 和 BL≥t1i1 的复合终点发生率分别为 5%和 14%。相比之下，终点发生在 5%的非排斥者和 21%的 T 细胞介导排斥者中。在验证队列中，BLt1i0 和 BL≥t1i1 分别有 8%和 36%达到终点。多变量 Cox 模型显示，BLt1i0 患者的预后与非排斥者相似（调整后的危险比，0.6；95%置信区间，0.1-2.2；P=0.40），但优于 BL≥t1i1 患者（危险比，3.8；95%置信区间，1.3-11.5；P=0.02）。将敏感性分析限制在死亡相关移植物丢失或使用移植后时间作为参考时间，提供了类似的结果。