移植肾的病理类型与肾功能及预后的关系——单中心十年经验回顾分析

目的 分析肾移植受者移植肾的病理类型和特征,及其与肾功能和预后的关系.方法 肾移植术后230例受者接受了移植肾穿刺病理活检,分析其病理表现类型和特征,比较不同病理类型和特征受者移植肾穿刺活检时的血肌酐(SCr)水平,随访受者穿刺活检后1年的移植肾功能情况,评价不同病理特征受者的预后.结果 移植术后3个月时接受了程序性肾活检的10例受者中,9例为正常肾组织,1例为移植后IgA肾病.有肾功能损害临床表现的220例受者中,病理表现为交界性改变33例,急性排斥反应(AR)45例,慢性排斥反应(CR)24例,慢性移植肾肾病(CAN)26例,移植后肾炎(PTGN)39例,以上共167例;另外,28例同时有前面两种或两种以上的病理类型表现,还有CNI肾毒性反应8例,BK病毒肾病7例,急性肾小管坏死5例.有5例受者因采集的移植肾组织过少而不能明确诊断.病理诊断为交界性改变、AR、CR、CAN和PTGN的受者,其穿刺活检时的SCr水平分别为(171±17)、(259±25)、(343±33)、(406±67)和(207±26)μmol/L,不同病理类型者的SCr水平两两比较,差异均有统计学意义(P＜0.01).穿刺活检后1年,随访到上述5种病理类型167例受者中的134例(80.2%),其中交界性改变23例、AR 36例、CR 20例、CAN 18例及PTGN37例,分别有1例(3.1%)、8例(18.2%)、8例(22.2%)、6例(33.3%)、5例(13.5%)发生移植肾功能丧失.穿刺活检后1年,上述5种病理类型移植肾功能异常受者的SCr水平与穿刺时SCr水平的差值(△SCr)分别为(-47±20.7)、(-37.3±36.9)、(25.5±24.3)、(13.5±27.7)和(25.2±17.1)μmol/L.结论 移植肾的病理改变复杂多样,结合移植肾穿刺病理活检结果和临床分析进行准确诊断,可以帮助临床选择合适的治疗方案,促进移植肾的长期存活.

Pathological type and characteristics of renal allograft after kidney transplantation and related clinical observation-10 years of experience in single-center retrospective analysis

Objective To investigate the pathological type and characteristics of renal allograft in kidney transplantation recipients,and to analyze the relevant clinical conditions and prognosis of renal function.Methods 230 patients received renal allograft biopsy after renal transplantation.The pathological type and characteristics of renal allograft specimens were observed,and the serum creatinine (SCr) in the recipients with different pathological types were analyzed.The function of renal allograft in the recipients was followed-up after one year,and their prognosis was evaluated.Results In 10 cases of protocol biopsy,normal renal tissues were found in 9 cases,IgA nephropathy occurred at the 3rd month after transplantation.In 220 cases having impaired renal function,there were 33 cases of borderline change,45 cases of acute rejection (AR),24 cases of chronic rejection (CR),26 cases of chronic allograft nephrapathy (CAN),and 39 cases of posttransplantation glomerulonephritis (PTGN).Except for above 167 cases,lesions of 28 cases showed multiple pathology types.Furthermore,there were 8 cases of calcineurin inhibitor nephrotoxicity (CNI-NT),7 cases of BK virus nephropathy (BKVN),and 5 cases of acute tubular necrosis (ATN).Five cases could not be diagnosed for little tissue.In the recipients with pathological diagnosis of borderline change,AR,CR,CAN and nephritis,SCr levels were (171 ± 17),(259 ± 25),(343 ± 33),(406 ± 67) and (207 ± 26) respectively.There was significant difference in SCr levels of recipients among the above 5 groups (P＜0.01).One year after biopsy,137 recipients (80.2%) were followed up.The dysfunction rate of renal allograft was 3.1%,18.2%,22.2 %,33.3% and 13.5% respectively.The △SCr was (-47 ± 20.7),(-37.3± 36.9),(25.5 ± 24.3),(13.5 ± 27.7) and (25.2 ± 17.1) μmol/L respectively.Conclusion Complex and diverse pathological changes were showed in renal allograft.Accurate diagnoses come from renal biopsy and clinical analysis may help clinicians select appropriate treatment programs to promote long-term graft survival.