移植肾内微淋巴管生成特点及其临床病理意义

2003(z4)

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Characteristic and clinicopathologic significance of lymphangiogenesis in kidney transplants

Objective To investigate the Characteristic and clinicopathologic significance of lymphangiogenesis in kidney transplants and their relationship with renaltransplant rejection. Methods Monoclonal podoplanin was used to immunostain the lymphatic microvessels in the 104 paraffin sections of renal transplant biopsies from 67 cases kept in the archives. The morphologic characterization and distribution of lymphatic microvessels, and the lymphatic vessel density (LVD) were compared between normal kidneys and grafts with different pathologic diagnosis. Results (1) No significant proliferation of lymphatic microvessels was observed in normal function renal grafts, and their location and number resembled that of normal kidneys. In the severe acute rejection kidney, lymphatic microvessels were variably larger, and denser confined to the adventitia of small-sized arteries. Numerous podoplanin-expressing lymphatic capillaries and larger caliber vessels are found within and around nodular mononuclear stromal infiltrates in the kidney transplants with chronic/sclerosing allograft nephropathy. (2) The LVD of normal kidney, stable function renal grafts and renal grafts with calciueurin inhibitor toxicity were 1.03±0.31, 1.76±0.52 and 1.87±1.13 respectively, there were not significant differences among this three groups (P＞0.05). The LVD in acute rejection group, C4d+ acute rejection group and chronic/sclerosing allograft nephropathy group were 3.33±0.92, 3.56±1.12 and 18.35±4.79 respectively, all significantly higher than that in stable function group (P＜0.01,0.01,0.01). Conclusions There are varied pathologic characterizations between different grading of rejection. The degree of lymphangiogenesis in renal grafts may be associated with pathologic grading of rejection.