Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Transplant Proc. 2024 Apr;56(3):499-504. doi: 10.1016/j.transproceed.2024.01.012. Epub 2024 Feb 5.
Perivascular aggregates (PVAs) often occur in kidney allografts; however, their significance needs to be re-evaluated in light of changes in the concept and criteria of allograft rejection.
We reviewed 1-year protocol biopsies in 258 patients with kidney transplants to identify PVAs and concurrent pathology based on the Banff 2017 classification, including revised criteria for chronic active T-cell mediated rejection (CA-TCMR). We investigated the incidence of PVA, concurrent allograft lesions, diagnosis, and graft survival. No prisoners were used in this study, and no participants were coerced or paid.
We identified PVA in 81 biopsies (31.4%). The incidence of previous rejection (32.1% vs 12.4%, P= .0003) and total inflammation (1.3 ± 0.8 vs 0.6 ± 0.8, P < .0001), inflammation (0.7 ± 0.8 vs 0.2 ± 0.5, P < .0001), inflammation in the area of interstitial fibrosis and tubular atrophy (1.3 ± 1.2 vs 0.7 ± 0.9, P < .0001), tubulitis (1.4 ± 1.1 vs 0.6 ± 0.9, P < .0001), and interstitial fibrosis scores (1.2 ± 0.9 vs 0.9 ± 0.9, P= .01) were higher in PVA-positive compared with patients with PVA-negative. Diagnoses in the PVA-positive group revealed no rejection in 49.4%, CA-TCMR in 21.0%, borderline changes in 18.5%, and acute TCMR in 6.2%. CA-TCMR was more frequent in patients with PVA-positive (21.0% vs 4.0%, P < .0001). Graft survival was similar in both groups among all patients, no-rejection, any type of rejection, and CA-TCMR subgroups.
PVAs occur heterogeneously and are associated with previous rejection or concurrent CA-TCMR. The prognostic significance of PVAs in kidney transplantation is inconclusive, and further investigations are needed.
血管周围聚集物（PVAs）常在肾移植中出现；然而，鉴于同种异体移植物排斥的概念和标准发生了变化，其意义需要重新评估。
我们回顾了 258 例肾移植患者的 1 年方案活检，根据 2017 年 Banff 分类识别 PVA 和并发的病理学，包括慢性活动性 T 细胞介导排斥反应（CA-TCMR）的修订标准。我们研究了 PVA 的发生率、并发的同种异体病变、诊断和移植物存活率。本研究未使用囚犯，也未对参与者进行胁迫或付费。
我们在 81 份活检中发现了 PVA（31.4%）。既往排斥反应的发生率（32.1%比 12.4%，P=.0003）和总炎症（1.3±0.8 比 0.6±0.8，P<.0001）、炎症（0.7±0.8 比 0.2±0.5，P<.0001）、间质纤维化和肾小管萎缩区域的炎症（1.3±1.2 比 0.7±0.9，P<.0001）、肾小管炎（1.4±1.1 比 0.6±0.9，P<.0001）和间质纤维化评分（1.2±0.9 比 0.9±0.9，P=.01）在 PVA 阳性组中更高。在 PVA 阳性组中，49.4%的患者无排斥反应，21.0%的患者为 CA-TCMR，18.5%的患者为边缘改变，6.2%的患者为急性 TCMR。PVA 阳性患者的 CA-TCMR 更常见（21.0%比 4.0%，P<.0001）。在所有患者、无排斥反应、任何类型排斥反应和 CA-TCMR 亚组中，两组的移植物存活率相似。
PVAs 呈异质性，与既往排斥反应或并发的 CA-TCMR 相关。PVAs 在肾移植中的预后意义尚不确定，需要进一步研究。
