transplantologiyaТрансплантологияTransplantologiya. The Russian Journal of Transplantation2074-05062542-0909IPO Association of Transplantologiststransplantologiya-140Research ArticleАКТУАЛЬНЫЕ ВОПРОСЫ ТРАНСПЛАНТОЛОГИИACTUAL ISSUES OF TRANSPLANTATIONФакторы риска и прогностическое значение микроваскулярного воспаления аллографта почкиRisk factors and prognostic significance of microvascular inflammation in the kidney allograftДобронравовВ. А.DobronravovV. A.dobronravov@nephrolog.ruХраброваМ. С.KhrabrovaM. S.face@neicon.ruНабоковА. В.NabokowA. W.face@neicon.ruСмирновА. В.SmirnovA. V.face@neicon.ruКлимФ.KliemV.face@neicon.ruФГБОУ ВО «Первый Санкт-Петербургский ГМУ им. акад. И.П. Павлова» МЗ РФРоссияAcademician I.P. Pavlov First Saint Petersburg State Medical UniversityRussian FederationНефрологический центр Нижней Саксонии, Ганн. МюнденРоссияDepartment of Nephrology, Nephrology Center of Lower Saxony, Hann. MuendenRussian Federation201613122016042737Copyright © Добронравов В.А., Храброва М.С., Набоков А.В., Смирнов А.В., Клим Ф., 20162016Добронравов В.А., Храброва М.С., Набоков А.В., Смирнов А.В., Клим Ф.Dobronravov V.A., Khrabrova M.S., Nabokow A.W., 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://www.jtransplantologiya.ru/jour/article/view/140

Актуальность: прогностическое значение микроваскулярного воспаления (МВВ) в отсутствие донор-специфических антител (ДСА) при аллотрансплантации почки (АТП) не определено, а предикторы развития такого варианта иммунного конфликта неизвестны.Целью исследования было определение прогностического значения МВВ и поиск ассоциированных с МВВ клинических факторов.Материал и методы. В исследование вошли 284 реципиента аллографта почки (АП) в соответствии с критериями включения: совместимость реципиента и донора по группе крови, отрицательный цитотоксический кросс-матч тест, наличие одной или более биопсий АП. У 150 больных регистрировали МВВ, а 134 пациента без МВВ составили группу сравнения. Регистрировали следующие клинические показатели: пол и возраст реципиента, возраст и тип донора (трупная АТП/от живого донора), длительность тепловой/холодовой ишемии, продолжительность заместительной почечной терапии, последнее значение уровня креатинина в крови донора, наличие отсроченной функции (ОФ) АП, иммунологический риск (ИР) (предсуществующие антитела, число HLAmm, количество предшествующих АТП), значения креатинина и протеинурии на момент биопсии. Анализ выживаемости АП оценивали методом Каплана–Мейера. Исходом считали достижение комбинированной конечной точки: возврат на диализ или показатель расчетной скорости клубочковой фильтрации – 15 мл/мин/1,73 м2 или менее. Для выявления независимых клинических факторов, ассоциированных с риском потери АП и развитием разных иммуноморфологических фенотипов МВВ, применяли мультивариантный регрессионный анализ Кокса.Результаты. По фенотипам МВВ пациентов распределили на следующие группы: случаи МВВ+ДСА+ (n = 31), соответствовавшие критериям антительно-опосредованного отторжения (Banff, 2013); случаи с МВВ+ДСА-(n = 62) и случаи с неопределенными ДСА (Luminex) (МВВ+ДСА?; n = 57). В подгруппе c МВВ+ДСА- 34 случая протекали с сопутствующим Т-клеточным отторжением (TCMR), а остальные 28 – в виде изолированного МВВ. Выживаемость АП при любом варианте МВВ была ниже, чем в группе сравнения. Медианы периода наблюдения от АТП и от биопсии составили 52 (23; 85) и 39 (13; 77) месяцев соответственно. МВВ было независимосвязано с риском потери АП (Exp(

Introduction: the prognostic significance of microvascular inflammation (MVI) in the absence of donor-specific antibodies (DSA) in kidney allotransplantation (KTx) is not well defined, and the predictors of such immune conflict type remain unclear.The study was aimed to define the long-term prognosis of MVI and to identify clinical factors associated with MVI.Material and methods. Two hundred eighty four kidney allograft (KA) recipients were enrolled into the study according to inclusion criteria (AB0-compatibility, negative cytotoxic crossmatch, and at least one KA biopsy in posttransplant period). One hundred fifty patients had MVI. The control group included 134 KTx recipients without MVI. The following clinical parameters were registered: he recipient’s gender and age, donor age, cadaveric/alive donor, cold/warm ischemia time, renal replacement therapy duration, last donor creatinine level, a delayed graft function (DGF), an immunological risk (IR) (number of HLAmm, panel-reactive antibodies, previous KTx), the level of creatinineand proteinuria at the time of biopsy. The long-term KA survival was estimated by Kaplan–Meier analysis. The combined end-point was determined as the return to dialysis or the estimated glomerular filtration rate 15 mL/min/1,73m2 or less. Multivariate Cox regression analysis was used for the evaluation of independent risk factors associated with the presence of MVI and risk of KA loss.Results. According to MVI phenotypes, the patients were distributed into the following groups: MVI+DSA+ cases (n=31) that met criteria for antibody-mediated rejection (Banff 2013); MVI+DSA- (n=62); and MVI+DSA? cases (n=57) with undetermined DSA. In MVI+DSA- group, 28 recipients had an isolated MVI, while MVI was accompanied withT-cell mediated rejection (TCMR) in 34 cases. The median follow-up was 52 (23; 85) months from KTx and 39 (13; 77) months from the biopsy. KA survival in all MVI groups was significantly lower compared with controls. In the adjusted multivariable Cox regression model, MVI was associated with the relative risk of KA loss (Exp(

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