Aims

Chronic-active antibody mediated rejection (c-aABMR) is a major cause of kidney graft loss. Currently, little is known about the relation between histopathologic parameters and renal allograft survival.

Methods and results

Between 2008 and 2014, 41 patients with a progressive decrease in renal function were diagnosed with c-aABMR according to Banff 2015 and followed up for at least 3 years. Clinical and renal biopsy characteristics were analyzed for association with graft survival.

During follow-up 26 cases lost their graft because of c-aABMR at a median follow up of 40 months after diagnosis.

Cases with v-lesions in their biopsy had a significant higher loss of eGFR prior to diagnosis. The total inflammation score (r = −0.45 p = .007) and the severity of interstitial fibrosis (r = −0.38 p = .023) were related to the eGFR at time of biopsy.

Univariate regression analysis showed that eGFR at time of biopsy, total inflammation, interstitial fibrosis and the sum chronicity score were significantly related to the risk for graft failure during follow-up. In a multivariate analysis only the severity of interstitial fibrosis remained associated with decreased graft survival (HR 1.9 per score point, 95% CI 1.2–2.8, p = .004).

Conclusion

Severity of renal interstitial fibrosis and not inflammation predicts graft survival in cases of c-aABMR.

中文翻译：

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班夫病灶和肾脏同种异体移植物在慢性活性抗体介导的排斥反应中存活。

目的

慢性活性抗体介导的排斥反应（c-aABMR）是肾移植物丢失的主要原因。目前，关于组织病理学参数与同种异体肾移植存活之间的关系知之甚少。

方法与结果

根据Banff 2015，在2008年至2014年间，有41例肾功能逐渐下降的患者被诊断为c-aABMR，并至少随访了3年。分析临床和肾脏活检特征与移植物存活的关系。

在随访期间，有26例患者在诊断后40个月的中位随访中因c-aABMR丢失了移植物。

活检中有v型病变的病例在诊断前有较高的eGFR损失。总的炎症评分（r  = -0.45 p  = .007）和间质纤维化的严重程度（r  = -0.38 p  = .023）与活检时的eGFR有关。

单因素回归分析显示，活检时的eGFR，总炎症，间质纤维化和慢性总和评分与随访期间移植失败的风险显着相关。在多变量分析中，仅间质纤维化的严重程度仍与移植物存活率降低相关（HR 1.9 /评分，95％CI 1.2-2.8，p  = .004）。

结论

肾间质纤维化的严重程度而非炎症程度可预测c-aABMR病例的移植物存活率。