期刊
AMERICAN JOURNAL OF TRANSPLANTATION
卷 8, 期 8, 页码 1662-1672出版社
WILEY-BLACKWELL
DOI: 10.1111/j.1600-6143.2008.02303.x
关键词
allograft; antibody; chronic; kidney; monkey; rejection
资金
- NHLBI NIH HHS [P01 HL018646-249001, P01 HL018646-239001, P01 HL018646-21A19001, P01 HL018646-22S19001, P01 HL018646-229001, HL18646, P01 HL018646, P01 HL018646-259001, P01 HL018646-31A16609] Funding Source: Medline
The etiology of immunologically mediated chronic renal allograft failure is unclear. One cause is thought to be alloantibodies. Previously in Cynomolgus monkeys, we observed a relationship among donor-specific alloantibodies (DSA), C4d staining, allograft glomerulopathy, allograft arteriopathy and progressive renal failure. To define the natural history of chronic antibody-mediated rejection and its effect on renal allograft survival, we now extend this report to include 417 specimens from 143 Cynomolgus monkeys with renal allografts. A subset of animals with long-term renal allografts made DSA (48%), were C4d positive (29%), developed transplant glomerulopathy (TG) (22%) and chronic allograft arteriopathy (CAA) (19%). These four features were highly correlated and associated with statistically significant shortened allograft survival. Acute cellular rejection, either Banff type 1 or 2, did not correlate with alloantibodies, C4d deposition or TG. However, endarteritis (Banff type 2) correlated with later CAA. Sequential analysis identified four progressive stages of chronic antibody-mediated rejection: (1) DSA, (2) deposition of C4d, (3) TG and (4) rising creatinine/renal failure. These new findings provide strong evidence that chronic antibody-mediated rejection develops without enduring stable accommodation, progresses through four defined clinical pathological stages and shortens renal allograft survival.
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