Corradetti Valeria, Gessaroli Elisa, Bari Federico, Bini Claudia, Grandinetti Valeria, Napoletano Angelodaniele, Cuna Vania, Pizzuti Valeria, Demetri Marcello, Ravaioli Matteo, Provenzano Michele, La Manna Gaetano, Comai Giorgia
Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40139 Bologna, Italy.
Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, 40126 Bologna, Italy.
J Clin Med. 2025 May 12;14(10):3373. doi: 10.3390/jcm14103373.
: Acute rejection (AR) in kidney transplant (KT) recipients remains a significant challenge for short- and long-term graft survival even in the most recent years characterized by extended criteria donors and older and more comorbid recipients. : We analyzed risk factors and outcomes of AR in 339 KT recipients treated at St. Orsola-Malpighi Hospital, Bologna (Italy), between 1 January 2019 and 31 December 2021. Demographic, immunological, and transplant data (type, cold ischemia time, complications) were recorded with a follow-up period of up to 24 months. Key outcomes included estimated glomerular filtration rate (eGFR), 24 h proteinuria, delayed graft function (DGF), biopsy-proven AR, and graft loss. : During the first year after transplant, 57 AR episodes occurred: 19 antibody-mediated rejections (AMR), 18 borderline T cell-mediated rejections (TCMR), 18 TCMR, 2 mixed AMR/TCMR, and 11 graft losses. AR was linked to older donor age (59.9 ± 12.8 vs. 55.5 ± 15.1, = 0.040), longer cold ischemia time (690 vs. 570 min, = 0.044), higher DGF rates (61.40% vs. 39.57%, = 0.002), and lower eGFR (39 vs. 52 mL/min, = 0.003). AR was consistently prevalent in patients who underwent an AB0-incompatible (AB0-i) transplant (8.8% vs. 2.5%, = 0.020). HLA matching was strongly associated with a reduced risk of AMR (HLA-DR: OR 0.35, HLA-A: OR 0.33, HLA-C: OR 0.35), while DGF was linked to a higher risk (OR 4.04). TCMR risk was associated with donor age (OR 1.05). The development of post-transplant donor-specific antibodies (DSAs) at 24 months showed no significant association with AR (AMR: = 0.769; TCMR: = 0.938). The decline in eGFR over time (24 months) did not differ between patients with and without AR (difference, -0.69 mL/min/year; Standard Error, 0.92; = 0.452). Similarly, 24 h proteinuria change over time did not differ between patients with and without AR (difference, -0.12 g/24 h; Standard Error, 0.28; = 0.657). : Understanding the risk factors of AR is crucial to identifying KTs at more risk of rejection and to guiding targeted therapeutic decisions. In the most recent era of extended criteria donors and more vulnerable recipients, early diagnosis and prompt and tailored treatment of AR play a critical role in stabilizing renal function over time.
即使在近年来以扩大标准供体以及年龄更大、合并症更多的受者为特征的情况下，肾移植（KT）受者的急性排斥反应（AR）对于短期和长期移植肾存活仍然是一项重大挑战。我们分析了2019年1月1日至2021年12月31日期间在意大利博洛尼亚圣奥索拉 - 马尔皮基医院接受治疗的339例KT受者的AR危险因素及结局。记录了人口统计学、免疫学和移植数据（类型、冷缺血时间、并发症），随访期长达24个月。主要结局包括估计肾小球滤过率（eGFR）、24小时蛋白尿、移植肾功能延迟恢复（DGF）、活检证实的AR以及移植肾丢失。在移植后的第一年，发生了57次AR发作：19次抗体介导的排斥反应（AMR）、18次临界T细胞介导的排斥反应（TCMR）、18次TCMR、2次混合性AMR/TCMR以及11次移植肾丢失。AR与供体年龄较大（59.9±12.8岁 vs. 55.5±15.1岁，P = 0.040）、冷缺血时间较长（690分钟 vs. 570分钟，P = 0.044）、较高的DGF发生率（61.40% vs.
