Volume 6 Issue 4
Jul.  2015
Turn off MathJax
Article Contents
Article Navigation >  ORGAN TRANSPLANTATION  > 2015  >  6(4): 224-229
Wang Guangce, Wang Suogang, Chen Zhu, et al. Study on clinicopathologic characteristics and individualized immunotherapy of antibody-mediated rejection after renal transplantation[J]. ORGAN TRANSPLANTATION, 2015, 6(4): 224-229. doi: 10.3969/j.issn.1674-7445.2015.04.004
Citation: Wang Guangce, Wang Suogang, Chen Zhu, et al. Study on clinicopathologic characteristics and individualized immunotherapy of antibody-mediated rejection after renal transplantation[J]. ORGAN TRANSPLANTATION, 2015, 6(4): 224-229. doi: 10.3969/j.issn.1674-7445.2015.04.004
shu

Study on clinicopathologic characteristics and individualized immunotherapy of antibody-mediated rejection after renal transplantation

doi: 10.3969/j.issn.1674-7445.2015.04.004

  • Department of Urology Surgery and Renal Transplantation, the First Affiliated Hospital of Henan Traditional Medical College, Zhengzhou 450003, China

More Information
  • Corresponding author: Wang Guangce.Email:wgc460@medmail.com.cn
  • Received Date: 2015-04-18
    Available Online: 2021-01-19
  • Publish Date: 2015-07-15
    Abstract
  •   Objective  To investigate clinicopathologic characteristics, individualized immunotherapy and prognosis of antibody-mediated rejection (AMR) after renal transplantation.  Methods  Clinical data of 32 patients, who were confirmed as AMR after renal transplantation by pathology and admitted in the Department of Urology and Renal Transplantation of the First Affiliated Hospital of Henan Traditional Medical College from January 2010 to December 2013, were retrospectively studied. The corresponding immunological intervention was adopted according to the clinicopathologic characteristics of different patients. The indicators including renal function, panel reactive antibody (PRA) and serum immunoglobulin (Ig) G, IgA and IgM level before and after treatment were determined, and adverse reactions were observed.  Results  Of all 32 patients, 18 developed acute antibody-mediated rejection (AAMR) and 14 developed chronic antibody-mediated rejection (CAMR). Of 13 PRA-positive patients, 8 (62%, 8/13) cases were with donor specific antibody and 5 (38%, 5/13) cases were with non-donor specific antibody. The primary pathological manifestations of early AAMR were changes of acute tubular necrosis (ATN), peritubular capillary inflammation, glomerulitis, fibrinoid necrosis of small arteries, linear C4d deposition in peritubular capillaries (PTC) and immunoglobulin or C3 deposition in arterial wall. The pathological manifestations of CAMR were changes of glomerulopathy, splitting of PTC basement membrane, fibrous intimal thickening and diffuse C4d deposition in PTC. After treatment, the renal function of 20 (63%, 20/32) patients returned to normal, the renal function of 7 (22%, 7/32) patients were stable, the serum creatinine (Scr) of 5 (16%, 5/32) patients increased slowly. Of such 5 patients, 2 (2/5) patients continued hemodialysis, 3 (3/5) patients did not need hemodialysis and no patient died. The indicators including blood urea nitrogen (BUN), Scr, PRA and serum IgG, IgA and IgM after treatment decreased significantly when compared with those before treatment (all in P < 0.01). No serious adverse reaction was noted during the treatment.  Conclusions  AMR may manifest as AAMR or CAMR after renal transplantation. The gold standard for diagnosing AMR is pathologic biopsy of transplant kidney. To adopt effective individualized immunotherapy in time is the critical measure for treatment of AMR.

     

    • FullText(HTML)
  • loading
    • References(15)
  • [1]
    Alvarez-Márquez A, Aguilera I, Gentil MA, et al. Donor-specific antibodies against HLA, MICA, and GSTT1 in patients with allograft rejection and C4d deposition in renal biopsies[J]. Transplantation, 2009, 87(1):94-99. doi: 10.1097/TP.0b013e31818bd790
    [2]
    孙启全, 季曙明.抗体介导的移植肾排斥[J].肾脏病与透析肾移植杂志, 2006, 15:282-289. http://d.wanfangdata.com.cn/Periodical/szbytxsyzzz200603017

    Sun QQ, Ji SM. Antibody-mediated rejection[J]. Chin J Nephrol Dial Transplant, 2006, 15:282-289. http://d.wanfangdata.com.cn/Periodical/szbytxsyzzz200603017
    [3]
    Seveso M, Bosio E, Ancona E, et al. De novo anti-HLA antibody responses after renal transplantation:detection and clinical impact[J]. Contrib Nephrol, 2009, 162:87-98. http://www.ncbi.nlm.nih.gov/pubmed/19001816
    [4]
    Melk A, Schmidt BM, Braun H, et al. Effects of donor age and cell senescence on kidney allograft survival[J]. Am J Transplant, 2009, 9(1):114-123. http://www.ncbi.nlm.nih.gov/pubmed/19133932
    [5]
    Randhawa PS, Schonder K, Shapiro R, et al. Polyomavirus BK neutralizing activity in human immunoglobulin preparations[J]. Transplantation, 2010, 89(12):1462-1465. doi: 10.1097/TP.0b013e3181daaaf1
    [6]
    Wang D, Xu TZ, Chen JH, et al. Factors influencing second renal allograft survival:a single center experience in China[J]. Transpl Immunol, 2009, 20(3):150-154. doi: 10.1016/j.trim.2008.09.010
    [7]
    Sis B, Mengel M, Haas M, et al. Banff' 09 meeting report:antibody mediated graft deterioration and implementation of Banff working groups[J].Am J Transplant, 2010, 10(3):464-471. doi: 10.1111/ajt.2010.10.issue-3
    [8]
    Kidney Disease:Improving Global Outcomes(KDIGO) Transplant Work Group. KDIGO clinical practice guideline for the care of kidney transplant recipients[J]. Am J Transplant, 2009, 9(Suppl 3):S1-S155. http://kdigo.org/home/guidelines/care-of-the-kidney-transplant-recipient/
    [9]
    Jirasiritham S, Khunprakant R, Techawathanawanna N, et al. Treatment of simultaneous acute antibody-mediated rejection and acute cellular rejection with alemtuzumab in kidney transplantation:a case report[J]. Transplant Proc, 2010, 42(3):987-989. doi: 10.1016/j.transproceed.2010.03.018
    [10]
    Obeidat MA, Luyckx VA, Grebe SO, et al. Post-transplant nuclear renal scans correlate with renal injury biomarkers and early allograft outcomes[J].Nephrol Dial Transplant, 2011, 26(9):3038-3045. doi: 10.1093/ndt/gfq814
    [11]
    Günther OP, Lin D, Balshaw RF, et al. Effects of sample timing and treatment on gene expression in early acute renal allograft rejection[J].Transplantation, 2011, 91(3):323-329. doi: 10.1097/TP.0b013e3182029b16
    [12]
    Haas M, Sis B, Racusen LC, et al. Banff 2013 meeting report:inclusion of c4d-negative antibody-mediated rejection and antibody-associated arterial lesions[J]. Am J Transplant, 2014, 14(2):272-283. doi: 10.1111/ajt.12590
    [13]
    王仁定, 王慧萍, 吴建永, 等.急性细胞性排斥伴补体裂解片断C4d沉积对移植肾预后的影响[J].器官移植, 2010, 1(3):141-143, 165. http://www.organtranspl.com/browse/detail/qkid/33/id/404

    Wang RD, Wang HP, Wu JY, et al. Effect of acute cellular rejection with C4d deposition on renal allograft survival[J].Organ Transplant, 2010, 1(3):141-143, 165. http://www.organtranspl.com/browse/detail/qkid/33/id/404
    [14]
    Singh N, Pirsch J, Samaniego M. Antibody-mediated rejection:treatment alternatives and outcomes[J].Transplant Rev, 2009, 23(1):34-46. doi: 10.1016/j.trre.2008.08.004
    [15]
    孙启全, 黎磊石, 唐政, 等.他克莫司联合霉酚酸酯治疗肾移植术后早期难治性急性体液性排斥的疗效[J].肾脏病与透析肾移植杂志, 2006, 1(15):12-17. http://www.cnki.com.cn/Article/CJFDTOTAL-SZBY200601002.htm

    Sun QQ, Li LS, Tang Z, et al. The efficacy of FK506 and mycophenolate mofetil rescue therapy for acute humoral rejection of kidney transplants[J]. Chin J Nephrol Dial Transplant, 2006, 1(5):12-17. http://www.cnki.com.cn/Article/CJFDTOTAL-SZBY200601002.htm
    • Relative Articles
    • Supplements(0)
    • Cited By
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(1)  / Tables(1)

    Get Citation
    PDF
    XML

    Article Metrics

    Article views (244) PDF downloads(16) Cited by()
    Proportional views
    Related

    WeChat Subscription Account

    Wechat Service Account

    Contact Us
    • Tel：020-38736410
    • Email: organtranspl@163.com
    • Address：The Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Tianhe District, Guangzhou
    • Editorial Office of Organ Transplantation  粤ICP备2021030844号
    Links

    Supported by: Beijing Renhe Information Technology Co. Ltd    

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return