Acute humoral rejection in renal allograft recipients: I. Incidence, serology and clinical characteristics.

摘要: Background. Acute rejection (AR) associated with de novo production of donor-specific antibodies (DSA) is a clinicopathological entity that carries poor prognosis (acute humoral rejection, AHR). The aim this study was to determine the incidence and clinical characteristics AHR in renal allograft recipients, further analyze involved. Methods. During 4-year period, 232 transplants (Tx) were performed at our institution. Assays for DSA included T B cell cytotoxic and/or flow cytometric cross-matches antibody screens (PRA). C4d complement staining on frozen biopsy tissue. Results. A total 81 patients (35%) suffered least one episode AR within first 3 months: 51 had steroid-insensitive whereas remaining 30 steroid-sensitive AR. No found In contrast, circulating 19/51 (37%) AR, widespread deposits peritubular capillaries present 18 these 19 (95%). three cases, against donor HLA class II antigens. not 32 but positive 2 32. DSA/C4d (n=18) negative (n=30) groups differed pre-Tx PRA levels, percentage re-Tx patients, refractoriness antilymphocyte therapy, outcome. Plasmapheresis tacrolimus-mycophenolate mofetil rescue reversed 9 10 recipients refractory AHR. Conclusion. More than one-third evidence AHR, often resistant therapy. Most cases (95%) time capillaries, suggesting pathogenic role alloantibody. Combined testing provides useful approach early diagnosis condition necessitates more intensive therapeutic regimen.