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首页> 外文期刊>Current opinion in organ transplantation >Pathology of C4d-negative antibody-mediated rejection in renal allografts.
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Pathology of C4d-negative antibody-mediated rejection in renal allografts.

机译：肾脏同种异体移植中C4d阴性抗体介导的排斥反应的病理学。

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To summarize current evidence supporting the existence of C4d-negative antibody-mediated rejection (AMR) in renal allografts, its potential to cause chronic graft injury, and whether histopathologic features of C4d-negative AMR differ from those of C4d-positive AMR.Recently published molecular, clinicopathologic, and ultrastructural studies provide strong evidence that microvascular injury in the presence of donor-specific alloantibodies (DSA) has the potential to cause interstitial fibrosis/tubular atrophy, transplant glomerulopathy, and graft loss, whether or not peritubular capillary (PTC) C4d is present. Although C4d-positive AMR may represent a more severe form of AMR, recent studies have found that in patients with DSA, microvascular injury (glomerulitis, peritubular capillaritis) is more strongly associated with graft loss than C4d deposition. Our data suggest that C4d-positive and C4d-negative AMR show similar degrees of glomerulitis and peritubular capillaritis, similar frequencies of concurrent cell-mediated rejection, and that both may occur early or late posttransplantation.In renal allografts, microvascular injury in the presence of DSA but with negative C4d staining in PTC nonetheless is indicative of humorally mediated graft injury that has the potential to cause tubular atrophy/interstitial fibrosis, transplant glomerulopathy, and graft loss. Prompt treatment for AMR may prevent or at least delay subsequent development of transplant glomerulopathy.
机译：总结目前支持肾同种异体移植中存在C4d阴性抗体介导排斥（AMR）的证据，其引起慢性移植物损伤的可能性以及C4d阴性AMR的组织病理学特征是否与C4d阳性AMR的病理学特征不同的最新证据。分子，临床病理学和超微结构研究提供了有力的证据，表明存在供体特异性同种抗体（DSA）的微血管损伤有可能导致间质纤维化/肾小管萎缩，移植肾小球病变和移植物丢失，无论是否存在肾小管周围毛细血管（PTC） C4d存在。尽管C4d阳性的AMR可能代表更严重的AMR形式，但是最近的研究发现，在DSA患者中，微血管损伤（肾小球炎，肾小管周围毛细血管炎）与移植物丢失的相关性比C4d沉积更强。我们的数据表明，C4d阳性和C4d阴性的AMR表现出相似程度的肾小球炎和肾小管周围毛细血管炎，相似的并发细胞介导排斥反应频率，并且两者都可能发生在移植后的早期或晚期。 DSA，但PTC中C4d染色为阴性，仍表明体液介导的移植物损伤可能导致肾小管萎缩/间质纤维化，移植肾小球病和移植物丢失。对AMR进行及时治疗可能会预防或至少延迟移植肾小球病变的后续发展。

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