Nephrology, Dialysis, and Transplantation, University of Genova, Ospedale Policlinico San Martino, Genova, Italy.
Renal Transplantation Unit, Ospedale Policlinico San Martino, Genova, Italy.
Clin Transplant. 2019 Jun;33(6):e13579. doi: 10.1111/ctr.13579. Epub 2019 May 22.
Macrophage infiltration is associated with unfavorable kidney graft outcome in protocol biopsies, but few studies have evaluated its impact on clinical practice. We therefore prospectively evaluated 37 kidney transplant recipients (KTRs) who underwent kidney biopsy due to slight increases in serum creatinine, or mild proteinuria (>0.3 g/24 hr), in the first post-transplant year. Banff score, CD68 count (score 0-3) by immunohistochemistry, and 1-year DSA were assessed. DGF was reported in 10 (27%) patients, 6 (16%) had normal biopsy, 7 (19%) borderline lesions, 13 (35%) IFTA, and 11 (30%) other lesions. Fifteen KTRs had grade 3 CD68 infiltration, and 47% developed de novo DSA. During a 6.2 ± 2.7 year follow-up, four patients (11%) suffered from biopsy-proven T-cell rejection, 17 KTRs (46%) lost their graft (12 in the grade 3 CD68 group). Graft survival was lower in KTRs with grade 3 CD68 infiltration (P = 0.0074; log-rank test). Grade 3 CD68 infiltrate was an independent predictor of graft loss (HR 5.41, 95% CI 1.74-16.8; P = 0.003), together with more severe graft dysfunction at biopsy (HR 6.41, 95% CI 2.57-16; P < 0.001). We conclude that grade 3 CD68 interstitial infiltration is associated with increased risk of subsequent graft loss independent of other factors.
巨噬细胞浸润与移植后早期协议活检中肾功能不良的移植物结局相关，但很少有研究评估其对临床实践的影响。因此，我们前瞻性评估了 37 例因移植后 1 年内血清肌酐轻度升高或轻度蛋白尿（>0.3g/24 小时）而接受肾活检的肾移植受者（KTR）。评估 Banff 评分、免疫组化 CD68 计数（评分 0-3）和 1 年 DSA。10 例（27%）患者报告发生 DGF，6 例（16%）活检正常，7 例（19%）边界病变，13 例（35%）IFTA，11 例（30%）其他病变。15 例 KTR 存在 CD68 浸润 3 级，47% 新发 de novo DSA。在 6.2±2.7 年的随访中，4 例患者（11%）发生经活检证实的 T 细胞排斥反应，17 例 KTR（46%）失功（CD68 浸润 3 级组 12 例）。CD68 浸润 3 级 KTR 的移植物存活率较低（P=0.0074；log-rank 检验）。CD68 浸润 3 级是移植物丢失的独立预测因子（HR 5.41，95%CI 1.74-16.8；P=0.003），与活检时更严重的移植物功能障碍相关（HR 6.41，95%CI 2.57-16；P<0.001）。我们的结论是，CD68 间质浸润 3 级与其他因素无关，与随后移植物丢失的风险增加相关。
