Neuzillet Yann, Luccioni Aline, Daniel Laurent, Lay Franck, Nahon Olivier, Lechevallier Eric, Berland Yvon, Coulange Christian
Service d'Urologie, Hôpital Salvator, Marseille, France.
Prog Urol. 2004 Feb;14(1):24-8.
The purpose of this study was to assess the correlations between histological examination of surgical biopsies before transplantation of good quality donor kidneys and delayed return of renal function and renal function at 1 year in order to determine whether histology could explain the various, sometimes surprising outcomes observed with these good quality transplants.
From November 1999 to March 2002, 110 consecutive renal transplantations were performed in our centre from 79 different donors, not including any "borderline" donors. During preparation of each transplant, a surgical wedge biopsy of the mid-renal cortex was performed. Biopsies were paraffin-embedded then stained with P.A.S. (Periodic Acid Shiff). Histological examination was performed by a single pathologist and focused on the glomeruli (number, morphology), and the morphology of the interstitial space and vessels. Delayed return of transplant renal function was defined by the need for dialysis during the first week after renal transplantation. Immunosuppression and surveillance protocols were standardized and uniform. Transplant function at 1 year was evaluated by serum creatinine and creatinine clearance calculated according to Cockcroft's formula.
The mean number of glomeruli per biopsy was 15.0 +/- 10.8. 42 renal biopsies (39.2%). Histological examination did not reveal any vascular, interstitial or glomerular lesions. Among these 42 transplants with normal biopsies, 30 (71.4%) did not develop delayed return of renal function (vs 69% of the transplants with abnormal biopsies, p > 0.05). Mean serum creatinine at 1 year (168.5 +/- 63 micromol/l vs 166.9 +/- 40.5 micromol/l, p > 0.05) and mean creatinine clearance at 1 year (53.4 +/- 17.4 ml/min. vs 48.3 +/- 14.3 ml/min, p > 0.05) were not significantly different between the normal biopsy group and the abnormal biopsy group.
Histological abnormalities are frequently observed in renal transplants derived from good quality donors. The biopsy result before renal transplantation from "non-borderline" donors was not significantly correlated with the risk of delayed return of transplant function or the renal function at 1 year Biopsy alone cannot constitute a reliable criterion for the selection of renal transplants from "non-borderline" donors.
本研究旨在评估优质供体肾移植前手术活检的组织学检查结果与肾功能延迟恢复及1年时肾功能之间的相关性，以确定组织学是否能够解释这些优质移植肾有时出现的各种令人惊讶的结果。
1999年11月至2002年3月，我们中心对来自79个不同供体的110例连续肾移植进行了研究，其中不包括任何“边缘性”供体。在每次移植准备过程中，对肾皮质中部进行手术楔形活检。活检组织经石蜡包埋后用P.A.S.（过碘酸希夫）染色。由一名病理学家进行组织学检查，重点关注肾小球（数量、形态）以及间质和血管的形态。移植肾功能延迟恢复的定义为肾移植后第一周需要进行透析。免疫抑制和监测方案是标准化且统一的。通过血清肌酐以及根据考克洛夫公式计算的肌酐清除率来评估1年时的移植肾功能。
每次活检的肾小球平均数量为15.0±10.8个。42例肾活检（39.2%）。组织学检查未发现任何血管、间质或肾小球病变。在这42例活检正常的移植肾中，30例（71.4%）未出现肾功能延迟恢复（活检异常的移植肾中这一比例为69%，p>0.05）。正常活检组和异常活检组1年时的平均血清肌酐（168.5±63微摩尔/升对166.9±40.5微摩尔/升，p>0.05）和1年时的平均肌酐清除率（53.4±17.4毫升/分钟对48.3±14.3毫升/分钟，p>0.05）无显著差异。
在来自优质供体的肾移植中经常观察到组织学异常。来自“非边缘性”供体的肾移植前活检结果与移植功能延迟恢复风险或1年时的肾功能无显著相关性。仅活检不能构成选择来自“非边缘性”供体肾移植的可靠标准。
