Owoyemi Itunu, Tandukar Srijan, Jorgensen Dana R, Wu Christine M, Sood Puneet, Puttarajappa Chethan, Sharma Akhil, Shah Nirav A, Randhawa Parmjeet, Molinari Michele, Tevar Amit D, Mehta Rajil B, Hariharan Sundaram
Department of Medicine, Thomas E Starzl Transplantation Institute, Pittsburgh, PA.
Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA.
Transplant Direct. 2021 Jun 8;7(7):e706. doi: 10.1097/TXD.0000000000001132. eCollection 2021 Jul.
Early acute kidney rejection remains an important clinical issue.
The current study included 552 recipients who had 1-2 surveillance or indication biopsy within the 1 y posttransplant. We evaluated the impact of type of allograft inflammation on allograft outcome. They were divided into 5 groups: no inflammation (NI: 95), subclinical inflammation (SCI: 244), subclinical T cell-mediated rejection (TCMR) (SC-TCMR: 110), clinical TCMR (C-TCMR: 83), and antibody-mediated rejection (AMR: 20). Estimated glomerular filtration rate (eGFR) over time using linear mixed model, cumulative chronic allograft scores/interstitial fibrosis and tubular atrophy (IFTA) ≥2 at 12 mo, and survival estimates were compared between groups.
The common types of rejections were C-TCMR (15%), SC-TCMR (19.9%), and AMR (3.6%) of patients. Eighteen of 20 patients with AMR had mixed rejection with TCMR. Key findings were as follows: (i) posttransplant renal function: eGFR was lower for patients with C-TCMR and AMR ( < 0.0001) compared with NI, SCI, and SC-TCMR groups. There was an increase in delta-creatinine from 3 to 12 mo and cumulative allograft chronicity scores at 12 mo ( < 0.001) according to the type of allograft inflammation. (ii) Allograft histology: the odds of IFTA ≥2 was higher for SC-TCMR (3.7 [1.3-10.4]; = 0.04) but was not significant for C-TCMR (3.1 [1.0-9.4]; = 0.26), and AMR (2.5 [0.5-12.8]; = 0.84) compared with NI group, and (iii) graft loss: C-TCMR accounted for the largest number of graft losses and impending graft losses on long-term follow-up. Graft loss among patient with AMR was numerically higher but was not statistically significant.
The type of kidney allograft inflammation predicted posttransplant eGFR, cumulative chronic allograft score/IFTA ≥2 at 12 mo, and graft loss.
早期急性肾移植排斥反应仍是一个重要的临床问题。
本研究纳入了552例在移植后1年内进行1 - 2次监测或指征性活检的受者。我们评估了同种异体移植炎症类型对同种异体移植结局的影响。他们被分为5组：无炎症（NI：95例）、亚临床炎症（SCI：244例）、亚临床T细胞介导的排斥反应（SC - TCMR：110例）、临床T细胞介导的排斥反应（C - TCMR：83例）和抗体介导的排斥反应（AMR：20例）。使用线性混合模型比较各组随时间的估计肾小球滤过率（eGFR）、12个月时累积慢性同种异体移植评分/间质纤维化和肾小管萎缩（IFTA）≥2的情况以及生存率估计值。
常见的排斥反应类型为C - TCMR（15%）、SC - TCMR（19.9%）和AMR（3.6%）的患者。20例AMR患者中有18例合并TCMR混合排斥反应。主要发现如下：（i）移植后肾功能：与NI、SCI和SC - TCMR组相比，C - TCMR和AMR患者的eGFR较低（<0.0001）。根据同种异体移植炎症类型，3至12个月时肌酐变化值增加，12个月时累积同种异体移植慢性评分增加（<0.001）。（ii）同种异体移植组织学：与NI组相比，SC - TCMR患者IFTA≥2的几率较高（3.7 [1.3 - 10.4]；P = 0.04），但C - TCMR（3.1 [1.0 - 9.4]；P = 0.26）和AMR（2.5 [0.5 - 12.8]；P = 0.84）患者不显著，（iii）移植物丢失：在长期随访中，C - TCMR导致的移植物丢失和即将发生的移植物丢失数量最多。AMR患者的移植物丢失在数值上较高，但无统计学意义。
同种异体肾移植炎症类型可预测移植后eGFR、12个月时累积慢性同种异体移植评分/IFTA≥2以及移植物丢失。
