Department of Pathology, Lab Medicine, Transfusion Services and Immunohematology; Department of Stem Cell Therapy and Regenerative Medicine, G. R. Doshi and K. M. Mehta Institute of Kidney Diseases and Research Centre and Dr. H. L. Trivedi Institute of Transplantation Sciences, Civil Hospital-Medicity Campus, Asarwa, Ahmedabad, India.
Department of Pathology, Lab Medicine, Transfusion Services and Immunohematology, G. R. Doshi and K. M. Mehta Institute of Kidney Diseases and Research Centre and Dr. H. L. Trivedi Institute of Transplantation Sciences, Civil Hospital-Medicity Campus, Asarwa, Ahmedabad, India.
Saudi J Kidney Dis Transpl. 2020 Nov-Dec;31(6):1331-1343. doi: 10.4103/1319-2442.308342.
Thrombotic microangiopathy (TMA) is devastating for renal transplantation (RT) causing graft/ patient loss. We present 5-year experience of TMA in RT in retrospective study of indicated renal allograft biopsies with TMA. Patient-donor demographics and associated histological findings with respect to transplants under tolerance induction protocol (Group 1) were compared with patients transplanted under triple immunosuppression (Group 2). Statistical analysis was performed using IBM SPSS Statistics version 20. Sixty-one (4.1%) of 1520 biopsies [Group 1:17 (1.9%)/882, Group 2:44 (6.9%)/638] revealed TMA. Tacrolimus trough levels were normal. There was no evidence of systemic involvement in any patient. Mean age was 36.8 years with 70.6% males, HLA-match, 2.6/6, and the most common original disease unknown (41.2%) in Group 1, and 35.9 years with 86.4% males, HLA-match, 2.1/6, and the most common original disease unknown (50%) in Group 2. Biopsies were performed at mean 5.1-year posttransplant in Group 1 and 2.3 years in Group 2. Acute TMA constituted 47% Group 1 and 43.2% Group 2 biopsies; of these, antibody-mediated rejections were observed in 58.8%, T-cell mediated rejections in 11.8%, tacrolimus toxicity in 76.5%, and other findings in 35.3% Group 1; and 61.4%, 25%, 50%, and 18.2%, respectively, in Group 2 biopsies. Higher rejection activity scores were more in Group 2. Postbiopsy 1- and 5- year patient survival was 94.1%, 86.9% in Group 1 and 92.1%, 88.3% in Group 2; 1- and 4-year graft survival was 52.9%, 15.9% in Group 1 and 20.3%, 5.4% in Group 2. TMA was poor prognosticator for RT, especially under triple immunosuppression. Antibody- mediated rejection and tacrolimus toxicity were more prone to TMA.
血栓性微血管病（TMA）对肾移植（RT）造成毁灭性影响，导致移植物/患者丧失。我们回顾性研究了 TMA 指示性肾移植活检，报告了 5 年 TMA 经验。将接受耐受诱导方案（第 1 组）和接受三联免疫抑制治疗（第 2 组）的患者的患者-供体人口统计学和相关组织学发现进行了比较。使用 IBM SPSS Statistics 版本 20 进行统计分析。在 1520 次活检中，有 61 次（4.1%）[第 1 组：17 次（1.9%）/882 次，第 2 组：44 次（6.9%）/638 次]显示 TMA。他克莫司谷浓度正常。在任何患者中均未发现有全身受累的证据。第 1 组的平均年龄为 36.8 岁，男性占 70.6%，HLA 匹配 2.6/6，最常见的原发病因不明（41.2%）；第 2 组的平均年龄为 35.9 岁，男性占 86.4%，HLA 匹配 2.1/6，最常见的原发病因不明（50%）。第 1 组和第 2 组的活检分别在移植后平均 5.1 年和 2.3 年进行。急性 TMA 构成第 1 组和第 2 组活检的 47%和 43.2%；其中，第 1 组观察到抗体介导的排斥反应占 58.8%，T 细胞介导的排斥反应占 11.8%，他克莫司毒性占 76.5%，其他发现占 35.3%；第 2 组分别为 61.4%、25%、50%和 18.2%。第 2 组的排斥活动评分更高。活检后 1 年和 5 年患者存活率分别为第 1 组 94.1%、86.9%和第 2 组 92.1%、88.3%；第 1 年和 4 年移植物存活率分别为第 1 组 52.9%、15.9%和第 2 组 20.3%、5.4%。TMA 是 RT 的不良预后因素，尤其是在三联免疫抑制下。抗体介导的排斥反应和他克莫司毒性更容易导致 TMA。
