Rush D
Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Transplant Proc. 2004 Mar;36(2 Suppl):71S-73S. doi: 10.1016/j.transproceed.2003.12.051.
Several groups have performed graft biopsies at set times posttransplant ("protocol biopsies") and found unequivocal histologic criteria for acute rejection in a high proportion of patients with stable graft function. The significance of "subclinical" rejection remains controversial. Our group and others have shown that clinically silent infiltrates have inflammatory and cytotoxic potential. Furthermore, in a randomized trial, we demonstrated that treatment of subclinical rejection results in better graft histology and renal function. Although a decrease in the prevalence of subclinical rejection may reduce the rate of late graft losses, the risks and cost of protocol biopsies require that noninvasive methods for the diagnosis of subclinical rejection be developed.
几个研究小组在移植后的特定时间进行了移植肾活检（“方案活检”），并在很大一部分移植肾功能稳定的患者中发现了明确的急性排斥反应组织学标准。“亚临床”排斥反应的意义仍存在争议。我们小组和其他研究小组已经表明，临床上无症状的浸润具有炎症和细胞毒性潜能。此外，在一项随机试验中，我们证明了亚临床排斥反应的治疗可使移植肾组织学和肾功能更好。虽然亚临床排斥反应发生率的降低可能会降低移植肾晚期丢失率，但方案活检的风险和成本要求开发非侵入性方法来诊断亚临床排斥反应。
