Introduction

Rejection is the most important problem for renal graft function and survival. Complement system plays a key role in immune responses from host to graft. It was demonstrated that complement system activation is related with renal fibrosis. We evaluate clinical impact of complement deposition findings on biopsies in acute rejection episodes of pediatric renal transplant patients.

Method

Demographics of the patients, graft functions, acute rejection episodes and graft loss were recorded from data files of 165 pediatric renal transplant patients. Findings of 98 renal biopsies were retrospectively evaluated.

Results

Thirty three patients with kidney transplant had 44 acute rejection episodes (32 pure cellular acute rejection episodes / 1 pure humoral acute rejection episode / 11 combined acute cellular and acute humoral rejection episodes) proven by biopsy. C1q staining was positive in 7 biopsies, C3 staining in 15 biopsies and, C4d staining in 15 biopsies. 26 patients had graft fibrosis. All patients with a rejection history had a significant decrease in GFR value during follow-up. Patients who did not have fibrotic changes in first biopsy had same level of deterioration of GFR when compared with patients who had fibrotic changes in first biopsy.

Conclusion

We could not demonstrate a significant relation between complement deposition and renal fibrosis, and between complement deposition and GFR values. Our data demonstrated that graft outcomes and graft loss after acute rejection episodes cannot be predicted only with complement deposition on graft or only with graft fibrosis.

中文翻译：

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补体沉积结果对小儿肾移植患者急性排斥反应活检的临床影响

介绍

排斥是肾移植物功能和存活最重要的问题。补体系统在宿主对移植物的免疫反应中起关键作用。已证明补体系统激活与肾纤维化有关。我们评估补体沉积结果对小儿肾移植患者急性排斥反应活检的临床影响。

方法

从 165 名小儿肾移植患者的数据文件中记录了患者的人口统计信息、移植物功能、急性排斥反应和移植物丢失。回顾性评估了 98 例肾活检的结果。

结果

33 例肾移植患者经活检证实有 44 次急性排斥反应（32 次纯细胞急性排斥反应/1 次纯体液急性排斥反应/11 次合并急性细胞和急性体液排斥反应）。C1q 染色阳性 7 例，C3 染色 15 例，C4d 染色 15 例。26 名患者出现移植物纤维化。所有有排斥史的患者在随访期间 GFR 值均显着下降。与第一次活检有纤维化改变的患者相比，第一次活检没有纤维化改变的患者的 GFR 恶化程度相同。

结论

我们无法证明补体沉积与肾纤维化之间以及补体沉积与 GFR 值之间存在显着关系。我们的数据表明，不能仅通过移植物上的补体沉积或仅与移植物纤维化来预测急性排斥事件后的移植物结果和移植物丢失。