移植肾临界改变的演变及其预后

目的 探讨移植肾临床改变的演变过程及其对肾移植长期效果的影响。方法 肾移植术后常规进行肾活检。对４６例首次病理确诊为“临界改变”，临床上伴有或不伴有移植肾功能异常者进行长期随访。结果 ４６例临界改变多发生于术后３个月内（４２例，占９１．３％）。１５例临界改变伴肾功能异常者经甲泼尼龙冲击强化治疗后，１２例于治疗后１个月，血肌酐降至正常，临界改变治疗组３年移植肾存活率明显高于对照组和临床改变未治疗组。

Borderline changes in sequential biopsies of kidney allograft recipients:clinicopathological evalution and graft outcome

Objective To evaluate the relationship between borderline changes and graft outcome in recipients of cadaveric kidney transplantation.Methods All biopsies were systematically evaluated according to Banff schema.PAP four-layer immunohistochemical staining was applied in the detection of CD4+,CD8+,CD68+,CD25+ cells,PCNA infiltration and HLA-DR protein synthesis.Patients with borderline change were analyzed by"intent to treat"and were followed up for aminimum of 3 yeres.Results 42 of the 46 recipients with"borderline changes" were diagnosed within 3 months after transplantation.Patients by"intent to treat"(Treated group) had a significant decrease in early acute rejection episodes and a lower serum creatinine at one month than in the untreated group.In borderline change biopsies,there were more infiltrating CD4+,CD8+,CD68+,CD25+ cells than in normal allografts,but still significantly less than those in allografts with acute rejection.Conclusions The early protocol biopsy and the treatment of borderline with corticosteroids may lead to better histological and functional outcomes in renal transplant recipients.