移植肾活检1500例病理组织学分析

目的 观察肾移植术后移植肾多种并发症的发生情况、病理组织学特点和活检诊断意义.方法 在超声引导下对1997年1月至2010年5月华中科技大学同济医学院附属同济医院器官移植研究所的1500例肾移植受者移植肾施行了1712次经皮肾穿刺活检并对活检组织标本予以相应染色和病理组织学观察.结果 肾移植术后可发生多种并发症,1500例中急性T细胞介导性排斥反应的发生率为14.2%(213例)、急性抗体介导性排斥反应发生率为2.4%(36例)、慢性T细胞介导性排斥反应发生率为16.7%(251例)、慢性抗体介导性排斥反应的发生率为3.0%(45例)、急性钙调磷酸酶抑制剂(CNI)类药物肾毒性损伤发生率为7.1%(106例)、慢性CNI类药物肾毒性损伤的发生率为16.7%(251例);复发/新发性肾病的发生率为0.4%(6例).排斥反应发生并不具有确定的时间界限.移植肾CNI类免疫抑制剂慢性毒性损伤是导致移植肾失功能的重要致病因素.结论 移植肾活检病理学观察可以及时、准确地诊断肾移植术后的多种并发症,肾移植临床中应常规规范开展移植肾活检病理学诊断.

Abstract：

Objective To summarize the histopathological features of posttransplant complications for renal allografts and evaluate the biopsy values. Methods Between January 1997 and May 2010, a total of 1712 percutaneous renal allograft biopsies were performed in 1500 kidney transplants and diagnostic procedures for staining, classification and staging had been performed according to the Banff 1997 and 2005 Schema. Results There were 213 ( 14.2% ) cases of acute T cell-mediated rejection post transplantation in 1500 kidney transplants. Meanwhile there were 36 ( 2.4%) cases of acute antibody-mediated rejection.Chronic T cell-mediated rejection and chronic antibody-mediated rejection were 251 ( 16.7% ) cases and 45 (3.0% )cases, respectively. Acute CNI-nephrotoxicity and chronic CNI-nephrotoxicity were 106 (7.1%)cases and 251 ( 16.7% ) cases, respectively. Relapsed or new nephropathy were 6 ( 0.4% ) cases. Chronic CNI-nephrotoxicity is the most common cause of allograft dysfunction in the long survival recipients.Conclusion Percutaneous renal allograft biopsy is valuable for the diagnosis of various posttransplantation complications.

Histopathologic analysis of 1500 renal allograft biopsies

Objective To summarize the histopathological features of posttransplant complications for renal allografts and evaluate the biopsy values. Methods Between January 1997 and May 2010, a total of 1712 percutaneous renal allograft biopsies were performed in 1500 kidney transplants and diagnostic procedures for staining, classification and staging had been performed according to the Banff 1997 and 2005 Schema. Results There were 213 ( 14.2% ) cases of acute T cell-mediated rejection post transplantation in 1500 kidney transplants. Meanwhile there were 36 ( 2.4%) cases of acute antibody-mediated rejection.Chronic T cell-mediated rejection and chronic antibody-mediated rejection were 251 ( 16.7% ) cases and 45 (3.0% )cases, respectively. Acute CNI-nephrotoxicity and chronic CNI-nephrotoxicity were 106 (7.1%)cases and 251 ( 16.7% ) cases, respectively. Relapsed or new nephropathy were 6 ( 0.4% ) cases. Chronic CNI-nephrotoxicity is the most common cause of allograft dysfunction in the long survival recipients.Conclusion Percutaneous renal allograft biopsy is valuable for the diagnosis of various posttransplantation complications.