ISSN:
1440-1797
Quelle:
Blackwell Publishing Journal Backfiles 1879-2005
Thema:
Medizin
Notizen:
SUMMARY: Three hundred fourteen 14th-postoperative-day routine renal allograft biopsies were evaluated together with clinical data. Out of 314 biopsies, mesangial IgA deposits were positive in 122 biopsies (39%). According to Banff classification, the rate of acute rejection was significantly lower in mesangial IgA deposit-positive (IgA(+)) patients (7.4%) than in mesangial IgA deposit-negative (IgA(-)) patients (19.7%) on the 14th postoperative day. Thereafter, rate of biopsy-proven and clinical acute rejection was continuously lower for up to 12 months in IgA(+) patients than in IgA(-) patients. the detection rate of mesangial IgA deposits was significantly higher in human leucocyte antigen (HLA)-well-matched (HLA mismatch number was 〈3) patients than in HLA-poorly matched (HLA mismatch number was 〈3) patients. In HLA-well-matched patients, the serum creatinine levels were significantly lower in IgA(+) patients than in IgA(-) patients after 3 post-transplant months and up to 1 post-transplant year. Follow-up (mean interval: 13 months) allograft biopsies were performed in 34 patients out of 122 IgA(+) patients. In the follow-up biopsies, initially detected mesangial IgA deposits had disappeared in 22 patients (65%) out of 34 patients. Twelve patients (35%) still had mesangial IgA deposits, and all of them had clinical and pathological findings consistent with IgA nephropathy. Patients with continuous mesangial IgA deposits in the follow-up biopsies had a better renal function at 1 year and a higher 5-year graft survival rate compared with patients who lost the initially deposited IgA. the present study demonstrates that long-lasting mesangial IgA deposits in renal transplants prevent allografts from acute rejection, which leads to better graft outcome.
Materialart:
Digitale Medien
URL:
http://dx.doi.org/10.1111/j.1440-1797.2002.tb00514.x
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