Piñeiro Gaston J, Montagud-Marrahi Enrique, Ríos José, Ventura-Aguiar Pedro, Cucchiari David, Revuelta Ignacio, Lozano Miquel, Cid Joan, Cofan Frederic, Esforzado Nuria, Palou Eduard, Oppenheimer Federico, Campistol Josep M, Bayés-Genís Beatriu, Rovira Jordi, Diekmann Fritz
Department of Nephrology and Kidney Transplantation, Hospital Clinic Barcelona, Barcelona, Spain.
Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
Front Med (Lausanne). 2021 Nov 12;8:761919. doi: 10.3389/fmed.2021.761919. eCollection 2021.
Despite recent advances in immunosuppression treatment, antibody-mediated rejection (ABMR) remains the leading cause of kidney graft loss. Information about prognostic markers and the efficacy of treatment is scarce. Retrospective study with kidney recipients diagnosed an active ABMR from January 1, 2004 to December 31, 2019 to explore the influence of persistent inflammation in follow-up biopsies on graft survival after ABMR treatment. About 116 patients were included. Active ABMR were treated with a combination of plasma exchange (PE), intravenous immunoglobulin (IVIg), rituximab, and steroids. At 6 months of treatment, 63 (54.3%) patients presented a stabilization or improvement in kidney-graft function. The effectiveness varied depending on the timepoint of the presentation between transplantation and rejection, which is lower for those with late ABMR (63 vs. 21% for early vs. late ABMR, respectively). Ninety patients (77%) underwent a control biopsy after ABMR treatment, from which 46 (51%) responded to the treatment. Microvascular inflammation (MVI) persisted in 64 (71%) biopsies, whereas tubulitis persisted in 17 (19%) biopsies. Death-censored graft survival at 1 year was significantly lower in patients with persistent MVI (86% vs. 95% without persistent MVI, = 0.002), or with persistent tubulitis (44% vs. 66% without tubulitis, = 0.02). In the Cox Regression analysis, the persistence of MVI [hazard ratio (HR), 4.50 (95%CI, 1.35-14.96), = 0.01] and tubulitis [HR 2.88 95%CI (1.24-6.69), = 0.01) in follow-up biopsies significantly increased the risk of graft failure. Persistent inflammation in follow-up biopsies after ABMR treatment was associated with an increased risk of graft loss, even without meeting Banff rejection criteria. Agencia Española de Medicamentos y Productos Sanitarios (AEMPS): 14566/RG 24161. Study code: UTRINM-2017-01.
尽管免疫抑制治疗最近取得了进展，但抗体介导的排斥反应（ABMR）仍然是肾移植失败的主要原因。关于预后标志物和治疗效果的信息很少。对2004年1月1日至2019年12月31日期间被诊断为活动性ABMR的肾移植受者进行回顾性研究，以探讨随访活检中持续性炎症对ABMR治疗后移植物存活的影响。纳入了约116例患者。活动性ABMR采用血浆置换（PE）、静脉注射免疫球蛋白（IVIg）、利妥昔单抗和类固醇联合治疗。治疗6个月时，63例（54.3%）患者的肾移植功能稳定或改善。疗效因移植与排斥反应之间的出现时间点而异，晚期ABMR患者的疗效较低（早期ABMR与晚期ABMR分别为63%和21%）。90例（77%）患者在ABMR治疗后接受了对照活检，其中46例（51%）对治疗有反应。64例（71%）活检中微血管炎症（MVI）持续存在，而17例（19%）活检中肾小管炎持续存在。持续性MVI患者1年时的死亡截尾移植物存活率显著较低（86%对无持续性MVI的患者为95%，P = 0.002），或持续性肾小管炎患者（44%对无肾小管炎的患者为66%，P = 0.02）。在Cox回归分析中，随访活检中MVI的持续存在[风险比（HR），4.50（95%CI，1.35 - 14.96），P = 0.01]和肾小管炎[HR 2.88 95%CI（1.24 - 6.69），P = 0.01]显著增加了移植物失败的风险。ABMR治疗后随访活检中的持续性炎症与移植物丢失风险增加相关，即使未达到班夫排斥标准。西班牙药品和卫生产品管理局（AEMPS）：14566/RG 24161。研究代码：UTRINM - 2017 - 01。
