vtioВестник трансплантологии и искусственных органовRussian Journal of Transplantology and Artificial Organs1995-1191Academician V.I.Shumakov National Medical Research Center of Transplantology and Artificial Organs", Ministry of Health of the Russian Federation10.15825/1995-1191-2014-2-30-38vtio-199Research ArticleКлиническая трансплантологияClinical TransplantologyМОРФОЛОГИЧЕСКИЕ ОСОБЕННОСТИ ПОЗДНЕГО ОТТОРЖЕНИЯ ТРАНСПЛАНТИРОВАННОЙ ПОЧКИ И ИХ ПРОГНОСТИЧЕСКОЕ ЗНАЧЕНИЕLATE RENAL GRAFT REJECTION: PATHOLOGY AND PROGNOSISСтоляревичЕ.С.StolyarevichE.S.stolyarevich@yandex.ruАртюхинаЛ.Ю.ArtyukhinaL.Y.1@ru.ruКимИ.Г.KimI.G.1@ru.ruКуренковаЛ.Г.KurenkovaL.G.1@ru.ruТомилинаН.А.TomilinaN.A.1@ru.ruОтделение нефрологических проблем трансплантации почки ФГБУ «ФНЦ трансплантологии и искусственных органов им. академика В.И. Шумакова» МЗ РФ, Москва, Кафедра нефрологии факультета постдипломного образования Московского государственного медико-стоматологического университета, Москва, ГКБ № 52, МоскваРоссияDivision of nephrology, V.I. Shumakov Federal Research Center of Transplantology and Artificial Organs, Moscow, Russian Federation Chair of Nephrology, Moscow University of Medicine and Dentistry, Moscow, Russian Federation Moscow City Hospital N 52, Russian FederationRussian FederationГКБ № 52, МоскваРоссияMoscow City Hospital N 52, Russian FederationRussian FederationОтделение нефрологических проблем трансплантации почки ФГБУ «ФНЦ трансплантологии и искусственных органов им. академика В.И. Шумакова» МЗ РФ, Москва, ГКБ № 52, МоскваРоссияDivision of nephrology, V.I. Shumakov Federal Research Center of Transplantology and Artificial Organs, Moscow, Russian Federation Moscow City Hospital N 52, Russian FederationRussian FederationОтделение патологической анатомии ФГБУ «ФНЦ трансплантологии и искусственных органов им. академика В.И. Шумакова» МЗ РФ, Москва,РоссияClinical pathology division at the same centerRussian Federation201426052014162ВЕСТНИК ТРАНСПЛАНТОЛОГИИ И ИСКУССТВЕННЫХ ОРГАНОВ том XVI No 2–20143038Copyright © Столяревич Е., Артюхина Л., Ким И., Куренкова Л., Томилина Н., 20142014Столяревич Е., Артюхина Л., Ким И., Куренкова Л., Томилина Н.Stolyarevich E., Artyukhina L., Kim I., Kurenkova L., Tomilina N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.transpl.ru/vtio/article/view/199

Отторжение трансплантата остается одной из наиболее частых причин дисфункции почечного трансплантата в поздние сроки после АТП. Цель исследования: проанализировать частоту встречаемости различных вариантов позднего отторжения трансплантата, выявить особенности их клинических проявлений и течения, а также определить морфологические и клинические факторы, определяющие прогноз нефропатии при различных типах позднего отторжения трансплантата. Материалы и методы. Проанализированы материалы 265 пациентов, которым в связи с поздней дисфункцией почечного трансплантата было выполнено 294 биопсии (в среднем через 48,8 ± 46,1 мес. после АТП), на основании чего верифицирован диагноз острого (n = 193) или хронического (n = 78) отторжения трансплантата либо (в 23 случаях) их сочетание. Результаты. Свечение C4d выявлялось в 36% случаев острого отторжения и в 62% случаев при ХОТ (в том числе при ХТГ – 67%, при васкулопатии – 50%). 5-летняя выживаемость трансплантатов составила 47, 13 и 25% при ООТ, ХОТ и сочетании ООТ+ХОТ соответственно (р < 0,01). При этом в случаях острого отторжения прогноз C4d+-форм был хуже, чем при отсутствии свечения C4d (53% vs 33%; р = 0.002), тогда как при хроническом отторжении подобная закономерность отсутствовала (36% vs 34%; p = NS). Выводы. Свечение C4d чаще выявляется при хроническом отторжении трансплантата, не влияя, однако, на его прогноз. При остром отторжении трансплантата свечение C4d отмечается реже, но является самостоятельным прогностическим фактором.

Rejection has always been one of the most important cause of late renal graft dysfunction. Aim of the study was to analyze the prevalence of different clinico-pathological variants of rejection that cause late graft dysfunction, and evaluate their impact on long-term outcome. Materials and methods. This is a retrospective study that analyzed 294 needle core biopsy specimens from 265 renal transplant recipients with late (48,8 ± 46,1 months after transplantation) allograft dysfunction caused by late acute rejection (LAR, n = 193) or chronic rejection (CR, n = 78) or both (n = 23). C4d staining was performed by immunofl uorescence (IF) on frozen sections using a standard protocol. Results. Peritubular capillary C4d deposition was identifi ed in 36% samples with acute rejection and in 62% cases of chronic rejection (including 67% cases of transplant glomerulopathy, and 50% – of isolated chronic vasculopathy). 5-year graft survival for LAR vs CR vs their combination was 47, 13 and 25%, respectively. The outcome of C4d– LAR was (p < 0,01) better than of C4d+ acute rejection: at 60 months graft survival for diffuse C4d+ vs C4d− was 33% vs 53%, respectively. In cases of chronic rejection C4d+ vs C4d– it was not statistically signifi cant (34% vs 36%). Conclusion. In long-term allograft biopsy C4d positivity is more haracteristic for chronic rejection than for acute rejection. Only diffuse C4d staining affects the outcome. C4d– positivity is associated with worse allograft survival in cases of late acute rejection, but not in cases of chronic rejection. 

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