背景:存在以肾小球白细胞边缘为特征的微血管炎症(MVI)(肾小球炎,班夫评分\'g\')和肾小管周围毛细血管(肾小管周围毛细血管炎,班夫评分\'ptc\')是抗体介导的排斥反应(AMR)的标志性组织学特征,即使在没有圆周C4d阳性的情况下。在这项研究中,我们评估了移植前血浆细胞因子作为辅助筛查工具的疗效,以在肾移植适应症活检中鉴定MVI,从而促进更好的移植物存活.
方法:这项单中心前瞻性分析研究包括38名肾移植受者,他们在移植前收集外周血,并评估FOXP3,IL-6,TGF-β,和IL-17使用酶联免疫吸附测定(ELISA)。在移植后适应症活检中进行组织病理学评估,计算\'g+ptc\'的Banff得分,将收件人分为三个MVI组。相关性,回归,和ROC曲线分析用于评估细胞因子与MVI的相关性和预测能力。
结果:在我们的研究队列中,27例患者MVI=0,5例患者MVI=1,6例患者MVI≥2。在这些组之间观察到血浆细胞因子的显着差异,我们发现FOXP3与MVI有很强的负相关,而IL-6、TGF-β、IL-17用MVI记录。我们还评估了这些细胞因子的预测能力,FOXP3,IL-6,TGF-β,和IL-17,通过ROC曲线,其显示AUC分别为0.70、0.76、0.84和0.72。
结论:我们的研究结果表明,移植前细胞因子FOXP3,IL-6,TGF-β,和IL-17可以被测量以识别有移植后MVI风险的受体,这可以进一步作为一个额外的工具,有效管理肾移植。
BACKGROUND: The presence of microvascular inflammation (MVI) characterized by leukocyte margination in the glomeruli (glomerulitis, Banff score \'g\') and peritubular capillaries (peritubular capillaritis, Banff score \'ptc\') is a hallmark histological feature of antibody-mediated rejection (AMR), even in the absence of circumferential C4d positivity. In this study, we assessed the efficacy of pre-transplant plasma cytokines as an ancillary screening tool to identify MVI in kidney allograft indication biopsies to facilitate better graft survival.
METHODS: This single-center prospective analytical study comprises 38 kidney transplant recipients whose peripheral blood was collected before transplant and assessed for the plasma cytokine concentrations of FOXP3, IL-6, TGF beta, and IL-17 using enzyme-linked immunosorbent assays (ELISA). Histopathological assessment was done in post-transplant indication biopsies, and Banff scores of \'g+ ptc\' were calculated to categorize recipients into three MVI groups. The correlational, regression, and ROC curve analyses were used to assess the association and predictive ability of the cytokines with respect to MVI.
RESULTS: In our study cohort, 27 recipients had MVI=0, five had MVI=1, and six had MVI≥2. A significant difference in plasma cytokines was observed between these groups, and we found a strong negative correlation of FOXP3 with MVI, whereas a strong positive correlation of IL-6, TGF beta, and IL-17 was recorded with MVI. We have also assessed the predictive ability of these cytokines, FOXP3, IL-6, TGF-beta, and IL-17, through the ROC curve, which showed an AUC of 0.70, 0.76, 0.84, and 0.72, respectively.
CONCLUSIONS: Our findings suggest that the pre-transplant levels of cytokines FOXP3, IL-6, TGF-beta, and IL-17 could be measured to identify recipients at risk of post-transplant MVI, which could further serve as an additional tool for effective management of the kidney allograft.