nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical Universitynefr-125Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИ КЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯORIGINAL ARTICLES CLINICAL STUDIESМикроваскулярное воспаление как прогностический фактор при трансплантации почкиMicrovascular inflammation as a prognostic factor in kidney transplantationХраброваМ. С.KhrabrovaM. .noemail@neicon.ruДобронравовВ. А.DobronravovV. A.vd1704@yandex.ruНабоковА. В.NabokowA. .noemail@neicon.ruГренеХ. -Й.GröneH. -J.noemail@neicon.ruХалленслебенМ. .HallenslebenM. .noemail@neicon.ruСмирновА. В.SmirnovA. V.noemail@neicon.ruКлимФ. .KliemV. .noemail@neicon.ruПервый Санкт-Петербургский медицинский университет им. акад. И.П. ПавловаРоссияPavlov First Saint-Petersburg State Medical UniversityRussian FederationНефрологический центр Нижней СаксонииРоссияNephrology center of Lower SaxonyRussian FederationГерманский центр изучения ракаРоссияGerman center of cancer researchRussian FederationИнститут трансфузионной медицины, Медицинская школа ГанновераРоссияInstitute of transfusion medicine Hannover Medical schoolRussian Federation2015010920151953441Copyright © Храброва М.С., Добронравов В.А., Набоков А.В., Грене Х.-., Халленслебен М..., Смирнов А.В., Клим Ф..., 20152015Храброва М.С., Добронравов В.А., Набоков А.В., Грене Х.-., Халленслебен М..., Смирнов А.В., Клим Ф...Khrabrova M..., Dobronravov V.A., Nabokow A..., Gröne H.-., Hallensleben M..., Smirnov A.V., Kliem V...Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/125

ЦЕЛЬ ИССЛЕДОВАНИЯ: оценить связь микроваскулярного воспаления (МВВ) и его компонентов (гломерулита, G) и перитубулярного капиллярита (PTC) с отдаленным прогнозом аллотрансплантата почки (АП). ПАЦИЕНТЫ И МЕТОДЫ: Из 1270 реципиентов с АП по наличию G отобраны случаи МВВ (G в сочетании с РТС или без такового, n=127), которые далее были разделены на группы: 1) G с положительными донор-специфическими антителами (DSA) (n=31); 2) G с отрицательными DSA (G+DSA-; n=62); 3) G с неуточненными DSA (n=34). По наличию Т-клеточного отторжения (TCMR, T-cell mediated rejection) G+DSA- разделили на две подгруппы: 1) изолированный G (isG, n=28); 2) G с сопутствующим TCMR IA/B или IIA/B типов (G+TCMR, n=34). C учетом возраста, типа и года АТП, количества несовпадений по HLA к пациентам с G подобрана контрольная группа реципиентов без отторжения (n=92), а к группе G+TCMR - 65 случаев TCMR без G. Все 284 пациента были разделены на подгруппы: 1) PTC+G+ (n=83); 2) PTC+G- (n=23); 3) PTC-G+ (n=44); 4) PTC-G- (n=144). Метод Каплана-Мейера применили для анализа выживаемости АП. Для оценки связи МВВ и других показателей с риском потери АП использовали множественный регрессионный анализ Кокса. Медиана периода наблюдения от биопсии составила 39 (13; 77) мес. РЕЗУЛЬТАТЫ: выживаемость АП была ниже при наличии МВВ (plog-rank <0,001). Выживаемость АП при наличии РТС в отсутствие гломерулита не отличалась от выживаемости в группе без каких-либо проявлений МВВ, а наличие G было связано с наименьшей выживаемостью аллографта почки вне зависимости от наличия/отсутствия PTC. G был также ассоциирован со снижением выживаемости АП при TCMR (plog-rank=0,021). Мультивариантный анализ показал, что наличие G связано с увеличением относительного риска потери АП в 4,5-5,4 раза (р<0,001) вне зависимости от наличия/отсутствия DSA. РТС не являлся независимым предиктором потери АП. ЗАКЛЮЧЕНИЕ: прогностическое значение МВВ определяется, главным образом, наличием гломерулита, который является независимым предиктором выживаемости АП. Своевременная диагностика этого типа морфологических изменений АП является важной для оценки прогноза и коррекции терапии в посттрансплантационном периоде.

THE AIM: to evaluate the association of microvascular inflammation (MVI) and its components (glomerulitis (G) and peritubular capillaritis (PTC)) with the long-term prognosis of renal allograft (RA). PATIENTS AND METHODS: Among 1270 recipients of RA 127 MVI cases with morphological features of G (±PTC) were enrolled into the study, including following groups: 1) G with positive DSA at the biopsy (n=31); 2) G with negative DSA (G+DSA-; n=62); 3) G with undetermined DSA (n=34). According to the presence of T-cell mediated rejection (TCMR) G+DSA- group was further subdivided into: 1) isolated G (isG, n=28); 2) G with concomitant TCMR types IA/B or IIA/B (G+TCMR, n=34). The control groups matched for age, HLA mismatch, year and type of RA included recipients without any rejection (n=92) and with TCMR types IA/B or IIA/B without G (n=65). All recipients enrolled into the study (n=284) were divided into following groups: 1) PTC+G+ (n=83); 2) PTC+G- (n=23); 3) PTC-G+ (n=44); 4) PTC-G- (n=144). Kaplan-Meier survival curves and multivariate Cox regression analysis were applied to estimate the association of MVI, including G and PTC with the risk of graft loss. The median follow-up was 39 (13; 77) months. RESULTS: The RA survival was significantly lower in the presence of MVI (plog-rank <0,001). There were no differences in survival in PTC+G- group and controls without MVI. The presence of G associated with inferior long-term survival irrespectively of presence or absence of PTC. RA survival in G+TCMR was lower than in TCMR without G (plog-rank=0,021). The presence of G was associated with 4,5-5,4-fold increase of related risks of graft loss in multivariable Cox regression analyses, while PTC was not identified as independent predictor of graft survival. CONCLUSION: The prognostic significance of MVI is mainly determined by the presence of G independently associated with RA survival. The early post-transplant diagnostic of G is important for the assessment of prognosis and modification of therapy.

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The authors declare that there are no conflicts of interest present.