Isolated v-lesion represents a benign phenotype of vascular rejection of the kidney allograft - a retrospective study
Jazyk angličtina Země Švýcarsko Médium print-electronic
Typ dokumentu časopisecké články
Grantová podpora
15-26519A
Ministry of Health of the Czech Republic - International
PubMed
29855106
DOI
10.1111/tri.13286
Knihovny.cz E-zdroje
- Klíčová slova
- antibody-mediated rejection, intimal arteritis, isolated v-lesion, kidney transplantation, vascular rejection,
- MeSH
- biopsie MeSH
- časové faktory MeSH
- dospělí MeSH
- fenotyp MeSH
- HLA antigeny imunologie MeSH
- imunosupresiva MeSH
- Kaplanův-Meierův odhad MeSH
- ledviny imunologie patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- přežívání štěpu MeSH
- protilátky imunologie MeSH
- rejekce štěpu imunologie MeSH
- renální insuficience chirurgie MeSH
- retrospektivní studie MeSH
- riziko MeSH
- T-lymfocyty imunologie MeSH
- transplantace ledvin škodlivé účinky MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- HLA antigeny MeSH
- imunosupresiva MeSH
- protilátky MeSH
While the detrimental impact of the humoral acute vascular rejection (AVR) phenotype is recognized, the prognostic significance of isolated v-lesion (IV) remains unclear. In this retrospective single-centre study, AVR was found in 98 of 1015 patients (9.7%) who had undergone kidney transplantation in 2010-2014, with donor-specific antibodies (DSA) evaluated in all of them. The outcome of four AVR phenotypes was evaluated during median follow-up of 59 months; in 25 patients with IV, 18 with T-cell-mediated vascular rejection (TCMVR), 19 with antibody-mediated vascular rejection (AMVR) and 36 with suspected antibody-mediated rejection (sAMVR). AVR was diagnosed mainly by for-cause biopsy (81%) early after transplantation (median 19 POD) and appeared as mild-grade intimal arteritis. IV occurred in low-sensitized patients after the first transplantation (96%) in the absence of DSA. IV responded satisfactorily to treatment (88%), showed no persistence of rejection in surveillance biopsy, and had stable graft function, minimal proteinuria and excellent DCGS (96%). Contrary to that, Kaplan-Meier estimate of 3-year DCGS of AMVR was 66% (log-rank = 0.0004). Early IV represents a benign phenotype of AVR with a favourable outcome. This study prompts further research to evaluate the nature of IV before considering any change in the classification and management.
Citace poskytuje Crossref.org
Antibody-mediated rejection of renal allografts: diagnostic pitfalls and challenges
Early isolated V-lesion may not truly represent rejection of the kidney allograft
