Journal of the American Society of Nephrology· 2015Q1
Böbrek Allogreftlerinin 1 Yıl Sonrası Subklinik Red Fenotipleri ve Sonuçları
Subclinical Rejection Phenotypes at 1 Year Post-Transplant and Outcome of Kidney Allografts
- 295atıf
- Q1SCImago
- 2015yıl
Kısa özet
Transplantasyondan 1 yıl sonra saptanan subklinik antikor aracılı red (ABMR), greft kaybı riskini bağımsız olarak 3.5 kat artırırken, subklinik T hücre aracılı redin (TCMR) etkisi daha az şiddetlidir.
Yapay zekâ ile başlık ve abstract'tan üretildi; tam metin okunmaz.
Ana noktalar
- Transplantasyondan 1 yıl sonra saptanan subklinik ABMR, uzun vadede böbrek allogreft sağkalımı ile anlamlı derecede ilişkilidir.
- 8 yıllık greft sağkalımı, subklinik ABMR'de %56, subklinik TCMR'de %88 ve red olmayanlarda %90 olarak bulunmuştur.
- Subklinik ABMR, çok değişkenli bir modelde greft kaybı riskinde 3.5 kat artışla bağımsız olarak ilişkilendirilmiştir.
- Subklinik ABMR, transplant glomerulopatisinde daha hızlı ilerleme ile ilişkilendirilmiştir.
Yapay zekâ ile başlık ve abstract'tan üretildi; tam metin okunmaz.
Özet (abstract)
Kidney allograft rejection can occur in clinically stable patients, but long-term significance is unknown. We determined whether early recognition of subclinical rejection has long-term consequences for kidney allograft survival in an observational prospective cohort study of 1307 consecutive nonselected patients who underwent ABO-compatible, complement-dependent cytotoxicity-negative crossmatch kidney transplantation in Paris (2000-2010). Participants underwent prospective screening biopsies at 1 year post-transplant, with concurrent evaluations of graft complement deposition and circulating anti-HLA antibodies. The main analysis included 1001 patients. Three distinct groups of patients were identified at the 1-year screening: 727 (73%) patients without rejection, 132 (13%) patients with subclinical T cell-mediated rejection (TCMR), and 142 (14%) patients with subclinical antibody-mediated rejection (ABMR). Patients with subclinical ABMR had the poorest graft survival at 8 years post-transplant (56%) compared with subclinical TCMR (88%) and nonrejection (90%) groups (P<0.001). In a multivariate Cox model, subclinical ABMR at 1 year was independently associated with a 3.5-fold increase in graft loss (95% confidence interval, 2.1 to 5.7) along with eGFR and proteinuria (P<0.001). Subclinical ABMR was associated with more rapid progression to transplant glomerulopathy. Of patients with subclinical TCMR at 1 year, only those who further developed de novo donor-specific antibodies and transplant glomerulopathy showed higher risk of graft loss compared with patients without rejection. Our findings suggest that subclinical TCMR and subclinical ABMR have distinct effects on long-term graft loss. Subclinical ABMR detected at the 1-year screening biopsy carries a prognostic value independent of initial donor-specific antibody status, previous immunologic events, current eGFR, and proteinuria.
Yazarların özeti; kaynağından alınmıştır. Journal of the American Society of Nephrology, 2015 · DOI ↗
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Alan: Transplantasyon (Organ Nakli)
TransplantationMedicine