Yamakawa Takafumi, Kobayashi Akimitsu, Yamamoto Izumi, Kawaguchi Takehiko, Imasawa Toshiyuki, Aoyama Hiromichi, Akutsu Naotake, Maruyama Michihiro, Saigo Kenichi, Yokoo Takashi, Kitamura Hiroshi
Department of Pathology, Chiba-East Hospital, Chiba, Japan.
Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
Nephrology (Carlton). 2018 Jul;23 Suppl 2:70-75. doi: 10.1111/nep.13276.
Arteriolar hyalinosis (AH) is a common lesion in allograft biopsies taken following kidney transplantation. Recent studies have shown that severe AH may predict transplant outcomes and provide information about previous exposure to certain drugs, such as calcineurin inhibitors (CNI). However, the incidence of AH as a direct result of diabetic nephropathy (DN) after kidney transplantation has not been fully evaluated. This study aimed to assess the impact of primary DN on the development of AH lesions in patients who underwent kidney transplantation.
Eighty-three patients who underwent living-donor kidney transplantation between April 2005 and June 2015 were enrolled in this study. A total of 33 patients had DN prior to transplantation. Allograft biopsies were scored according to the Banff classification, and the relationship between the individual histological lesions and clinical baseline data was assessed.
At early biopsy (3-12 months), there were no differences in the rates of AH lesions between the DN group and the non-DN group (ah ≥ 1: 37% vs. 41.3%, P = 0.719; aah ≥ 1: 14.8% vs. 6.5%; P = 0.453). However, there were significant differences between the groups in biopsies taken more than 3 years after the transplant (ah ≥ 2: 83.3% vs. 36.8%, P = 0.013; aah ≥ 2: 66.7% vs. 21.1%, P = 0.011). Multivariable analysis showed that both the length of time after transplantation and the presence of DN were independent risk factors for ah ≥ 2 (odds ratio [OR]: 2.55, 95% confidence interval [CI]: 1.47-19.54, P = 0.011) and aah ≥ 2 (OR: 7.55, 95% CI: 1.49-38.33, P = 0.015).
This is the first report showing that the presence of primary DN disease contributes to the development of severe AH late in the course after kidney allografts.
肾小动脉玻璃样变（AH）是肾移植后同种异体移植肾活检中常见的病变。近期研究表明，严重的AH可能预示移植结果，并能提供有关既往接触某些药物（如钙调神经磷酸酶抑制剂[CNI]）的信息。然而，肾移植后糖尿病肾病（DN）直接导致AH的发生率尚未得到充分评估。本研究旨在评估原发性DN对肾移植患者AH病变发生发展的影响。
本研究纳入了2005年4月至2015年6月期间接受活体供肾移植的83例患者。共有33例患者在移植前患有DN。根据Banff分类法对移植肾活检进行评分，并评估个体组织学病变与临床基线数据之间的关系。
在早期活检（3 - 12个月）时，DN组和非DN组的AH病变发生率无差异（ah≥1：37%对41.3%，P = 0.719；aah≥1：14.8%对6.5%；P = 0.453）。然而，在移植后3年以上进行的活检中，两组之间存在显著差异（ah≥2：83.3%对36.8%，P = 0.013；aah≥2：66.7%对21.1%，P = 0.011）。多变量分析显示，移植后时间长短和DN的存在都是ah≥2（比值比[OR]：2.55，95%置信区间[CI]：1.47 - 19.54，P = 0.011）和aah≥2（OR：7.55，95% CI：1.49 - 38.33，P = 0.015）的独立危险因素。
这是首份表明原发性DN疾病的存在会促使肾移植后晚期严重AH发生发展的报告。
