慢性活性抗体介导的排斥反应(CAABMR)是晚期同种异体肾丢失的重要原因。移植后早期炎症事件如急性排斥反应和感染被认为是新生供体特异性抗体(dnDSA)产生的危险因素。在这项研究中,我们研究了T细胞介导的排斥反应与dnDSA阳性CAABMR之间的关系.
我们招募了365名在我们医院接受ABO相容性肾移植的患者。其中,16例诊断为dnDSA阳性CAABMR的患者被指定为CAABMR组,随机选取38例患者作为对照组.移植后1个月的所有活检都包括在研究中。是否存在边界线变化(BLCs),急性T细胞介导的排斥反应(ATMR),微血管炎症(MVI),检查肾小管周围毛细血管C4d阳性(C4d-P)。
在CAABMR组中,12例(75%)发现BLC/ATMR,直到BLC/ATMR出现的平均持续时间为282.7±328.7天。C4d-P11例(68.8%),直到它出现的平均持续时间为1,432±1,307天。所有病例都发现了MVI,直到它出现的平均持续时间为1,333±1,126天。直到诊断为CAABMR的平均持续时间为2,268±1,191天。在对照组中,13例(34.2%)发现BLC/ATMR,直到BLC/ATMR出现的平均持续时间为173.1±170.4天。C4d-P2例(5.3%),直到它出现的持续时间为748天和1,881天。对照组未发现MVI。CAABMR组BLC/ATMR频率明显增高(p<0.01)。
前BLC/ATMR与带有dnDSA的CAABMR的发展有关。
Chronic active antibody-mediated rejection (CAABMR) is an important cause of late-stage renal allograft loss. Early inflammatory events such as acute rejection and infection after transplantation are considered to be the risk factors of de novo donor-specific antibody (dnDSA) production. In this study, we investigated the relationship between pre-disposing T-cell-mediated rejection and dnDSA-positive CAABMR.
We recruited 365 patients who underwent ABO-compatible renal transplantation at our hospital. Among them, 16 patients diagnosed as having dnDSA-positive CAABMR were designated as a CAABMR group, and 38 randomly selected patients were designated as a control group. All biopsies from 1 month after transplantation were included in the study. The presence or absence of borderline changes (BLCs), acute T-cell-mediated rejection (ATMR), microvascular inflammation (MVI), and C4d positive on peritubular capillaries (C4d-P) was examined.
In the CAABMR group, BLC/ATMR was found in 12 cases (75%), and the mean duration until appearance of BLC/ATMR was 282.7 ± 328.7 days. C4d-P was found in 11 cases (68.8%), and the mean duration until its appearance was 1,432 ± 1,307 days. MVI was found in all cases, and the mean duration until its appearance was 1,333 ± 1,126 days. The mean duration until diagnosis of CAABMR was 2,268 ± 1,191 days. In the control group, BLC/ATMR was found in 13 cases (34.2%), and the mean duration until the appearance of BLC/ATMR was 173.1 ± 170.4 days. C4d-P was found in 2 cases (5.3%), and the durations until its appearance were 748 and 1,881 days. No cases of MVI were found in the control group. The frequency of BLC/ATMR was significantly higher in the CAABMR group (p < 0.01).
Preceding BLC/ATMR is associated with the development of CAABMR with dnDSA.