Aziz Fahad, Parajuli Sandesh, Mohamed Maha, Garg Neetika, Muth Brenda, Mandelbrot Didier, Ellis Thomas, Zhong Weixiong, Djamali Arjang
Clin Nephrol. 2019 Feb;91(2):95-100. doi: 10.5414/CN109484.
Risk factors for graft loss in kidney transplant recipients with g3 lesions are poorly defined.
We evaluated outcomes in 37 consecutive kidney transplant biopsies diagnosed with g3 glomerulitis based on Banff 2013 criteria in a single-center observational study.
The diagnosis of g3 glomerulonephritis was made 6.1 ± 6.6 years after transplant. The majority of patients were Caucasian (86%), male (65%), and received basiliximab induction (54%). At the time of biopsy, all were on triple therapy with tacrolimus, mycophenolate, and prednisone. Mean serum creatinine (Scr) was 2.85 ± 2.1 mg/dL. Notably, 20 (54%) were positive for donor-specific antibodies (DSA) and 8 (22%) were C4d, while 24 (65%) had transplant glomerulopathy (TG). Treatment included pulse steroids/intravenous immunoglobulin (IVIG) (73%) and rituximab (51%). Patients were followed for up to 4 years after the biopsy. Eleven grafts (30%) were lost during the follow-up. Cox regression analyses determined Scr (HR = 1.63, 95% CI 1.19 - 2.24, p = 0.002), live donor status (HR = 0.18, 95% CI 0.04 - 0.90, p = 0.03), t-score (HR = 2.75, 95% CI 1.30 - 5.81, p = 0.008), and ct-score (HR = 2.19, 95% CI 1 - 4.75, p = 0.04) as significant predictors of graft loss.
CONCLUSION: Severe glomerulitis was associated with a high prevalence of TG and graft loss at 4 years. Live donor status, kidney function (Scr), and tubular injury (t- and ct-scores) were independently associated with graft loss. Interventional mechanistic clinical trials are needed to better understand the pathogenesis and outcomes of g3 glomerulitis. .
g3病变的肾移植受者移植物丢失的危险因素尚不明确。
在一项单中心观察性研究中，我们根据2013年班夫标准对37例连续诊断为g3肾小球炎的肾移植活检结果进行了评估。
移植后6.1±6.6年诊断为g3肾小球肾炎。大多数患者为白种人（86%），男性（65%），接受巴利昔单抗诱导治疗（54%）。活检时，所有患者均接受他克莫司、霉酚酸酯和泼尼松三联治疗。平均血清肌酐（Scr）为2.85±2.1mg/dL。值得注意的是，20例（54%）供者特异性抗体（DSA）呈阳性，8例（22%）C4d呈阳性，24例（65%）有移植肾小球病（TG）。治疗包括脉冲类固醇/静脉注射免疫球蛋白（IVIG）（73%）和利妥昔单抗（51%）。活检后对患者进行了长达4年的随访。随访期间11个移植物（30%）丢失。Cox回归分析确定Scr（HR=1.63，95%CI 1.19-2.24，p=0.002）、活体供者状态（HR=0.18，95%CI 0.04-0.90，p=0.03）、t评分（HR=2.75，95%CI 1.30-5.81，p=0.008）和ct评分（HR=2.19，95%CI 1-4.75，p=0.04）是移植物丢失的重要预测因素。
严重肾小球炎与4年时TG的高患病率和移植物丢失相关。活体供者状态；肾功能（Scr）和肾小管损伤（t评分和ct评分）与移植物丢失独立相关。需要进行干预性机制临床试验以更好地了解g3肾小球炎的发病机制和结局。
