器官移植2025，Vol.16Issue(4)：565-573,9.DOI:10.12464/j.issn.1674-7445.2025096
肾移植术后慢性活动性抗体介导的排斥反应预后相关危险因素分析
Analysis of prognostic risk factors for chronic active antibody-mediated rejection after kidney transplantation
摘要
Abstract
Objective To investigate the independent risk factors affecting the prognosis of chronic active antibody-mediated rejection(caAMR)after kidney transplantation.Methods A retrospective analysis was conducted on 61 patients who underwent renal biopsy and were diagnosed with caAMR.The patients were divided into caAMR group(n=41)and caAMR+TCMR group(n=20)based on the presence or absence of concurrent acute T cell-mediated rejection(TCMR).The patients were followed up for 3 years.The value of 24-hour urinary protein and estimated glomerular filtration rate(eGFR)at the time of biopsy in predicting graft loss was assessed using receiver operating characteristic(ROC)curves.The independent risk factors affecting caAMR prognosis were analyzed using the LASSO-Cox regression model.The correlation between grouping,outcomes,and Banff scores was compared using Spearman rank correlation matrix analysis.Kaplan-Meier analysis was used to evaluate the renal allograft survival rates of each subgroup.Results The 3-year renal allograft survival rates for the caAMR group and the caAMR+TCMR group were 83％and 79％,respectively.The area under the ROC curve(AUC)for predicting 3-year renal allograft loss was 0.83[95％confidence interval(CI)0.70-0.97]for eGFR and 0.78(95％CI 0.61-0.96)for 24-hour urinary protein at the time of biopsy.LASSO-Cox regression analysis and Kaplan-Meier analysis showed that eGFR≤25.23 mL/(min·1.73 m2)and the presence of donor-specific antibody(DSA)against human leukocyte antigen(HLA)class I might be independent risk factors affecting renal allograft prognosis,with hazard ratios of 7.67(95％CI 2.18-27.02)and 5.13(95％CI 1.33-19.80),respectively.A strong correlation was found between the Banff chronic lesion indicators of renal interstitial fibrosis and tubular atrophy(P<0.05).Conclusions The presence of HLA class I DSA and eGFR≤25.23 mL/(min·1.73 m²)at the time of biopsy may be independent risk factors affecting the prognosis of caAMR.关键词
肾移植/慢性排斥反应/抗体介导的排斥反应/T细胞介导的排斥反应/供者特异性抗体/人类白细胞抗原/估算肾小球滤过率/移植肾丢失Key words
Kidney transplantation/Chronic rejection/Antibody-mediated rejection/T cell-mediated rejection/Donor specific antibody/Human leukocyte antigen/Estimated glomerular filtration rate/Renal graft loss分类
医药卫生引用本文复制引用
惠宇,蒋昊,周政,胡林昆,王亮良,潘浩,魏雪栋,黄玉华,侯建全..肾移植术后慢性活动性抗体介导的排斥反应预后相关危险因素分析[J].器官移植,2025,16(4):565-573,9.基金项目
国家自然科学基金(82270787) （82270787）
苏州大学附属第一医院自然科学基金博习培育计划(BXQN2023026) （BXQN2023026）
