Sousa Marcos Vinicius de, Zollner Ricardo de Lima, Mazzali Marilda
Universidade de Campinas, Departamento de Clínica Médica, Faculdade de Ciências Médicas, Laboratório de Investigação em Transplante, Campinas, SP, Brasil.
Universidade de Campinas, Faculdade de Ciências Médicas, Departamento de Clínica Médica, Laboratório de Imunologia Translacional, Campinas, SP, Brasil.
J Bras Nefrol. 2019 Sep 12;42(2):201-210. doi: 10.1590/2175-8239-JBN-2018-0244.
Renal fibrosis is the end point of a process that begins at transplant, with ischemia reperfusion and early inflammation, and progresses over time with immunological and non-immunological phenomena. Early identification of morphological markers and intervention could improve graft function and survival.
to evaluate the correlation between intensity and specificity of pre-transplant anti-HLA antibodies and kidney allograft pathology in order to identify early risk factors or markers of allograft dysfunction.
A retrospective cohort of kidney transplant recipients with pre-transplant anti-HLA antibodies who underwent graft biopsy within the first two years post-transplant was divided into two groups according to the specificity of anti-HLA antibodies: nonspecific (non-DSA, n = 29) and specific (DSA+, n = 16). Kidney graft pathology, renal function, and proteinuria were analyzed.
general characteristics were similar in both groups, except for the higher dose of thymoglobulin in DSA+ group (p < 0.05). The non-DSA group had higher scores for glomerulosclerosis, interstitial inflammation (i) and interstitial fibrosis (ci) (p < 0.05) and higher incidence of cell-mediated acute rejection. No statistical difference in incidence of antibody-mediated rejection, renal function, and proteinuria was observed during follow up.
the difference in inflammation scores and interstitial fibrosis may be associated to the higher incidence of acute cell-mediated rejection and polyomavirus nephropathy in the Non-DSA group. We also should take into account the protective effect of higher doses of thymoglobulin, reducing ischemia reperfusion injury in the DSA+ group. The short follow-up might have been insufficient to detect long-term changes in allograft tissue, renal function, and proteinuria.
肾纤维化是一个始于移植的过程的终点，该过程始于缺血再灌注和早期炎症，并随着时间推移因免疫和非免疫现象而进展。早期识别形态学标志物并进行干预可改善移植肾功能和存活率。
评估移植前抗HLA抗体的强度和特异性与肾移植病理之间的相关性，以确定移植功能障碍的早期危险因素或标志物。
对一组移植前有抗HLA抗体且在移植后两年内接受移植肾活检的肾移植受者进行回顾性队列研究，根据抗HLA抗体的特异性将其分为两组：非特异性（非DSA，n = 29）和特异性（DSA +，n = 16）。分析移植肾病理、肾功能和蛋白尿情况。
两组的一般特征相似，但DSA +组的抗胸腺细胞球蛋白剂量较高（p < 0.05）。非DSA组的肾小球硬化、间质炎症（i）和间质纤维化（ci）评分较高（p < 0.05），细胞介导的急性排斥反应发生率也较高。随访期间，抗体介导的排斥反应发生率、肾功能和蛋白尿方面未观察到统计学差异。
炎症评分和间质纤维化的差异可能与非DSA组急性细胞介导的排斥反应和多瘤病毒肾病的较高发生率有关。我们还应考虑较高剂量抗胸腺细胞球蛋白的保护作用，其可减少DSA +组的缺血再灌注损伤。较短的随访时间可能不足以检测移植组织、肾功能和蛋白尿的长期变化。
