Sulikowski T, Tejchman K, Domański L, Urasińska E, Kamiński M, Zietek Z, Sieńko J, Romanowski M, Safranow K, Bohatyrewicz R, Ciechanowski K, Ostrowski M
Department of General Surgery and Transplantation, Pomeranian Medical University, Szczecin, Poland.
Transplant Proc. 2007 May;39(4):943-7. doi: 10.1016/j.transproceed.2007.03.060.
Many factors affect long-term results in kidney transplantation including histologic damage as a independent predictor, such as chronic allograft/nephropathy in protocol biopsies and age-dependent lesions. Histopathologic findings correlate with the incidence of delayed graft function, renal function, and allograft survival, allowing a rather precise prediction of graft outcome.
We analyzed 92 renal thick needle preimplantation and 29 postexplantation biopsies. Biopsies were preserved in 4% formalin and immersed in paraffin. Optimal biopsies contained at least 10 glomeruli and at least 2 cross-sections of arteries. We analyzed tubulitis, intensity of acute tubular necrosis, inflammatory infiltration, glomerulonephritis, arterial hyalinization, arteritis, fibrosis, tubular atrophy, arterial intimal fibrosis, increase of mesangial matrix, and percentage of glomerulosclerosis. During the postoperative course we analyzed patients condition, exigency of postoperative dialysis, urine output, as well as serum concentrations of creatinine, urea, uric acid, and ions. During a 1-year observation period, we analyzed living recipients, graft loss, death with a functioning graft, incidence of nephropathy (CAN), and acute rejection episodes (ARE).
We observed a significant correlation between immediate graft function (IGF) and lack of ATN in the pre-0 biopsy. We observed no correlation between renal function and arterial hyalinization and fibrosis, inflammatory infiltration, tubular atrophy. In the postoperative period, we observed a significant correlation between IGF and lack of interstitial fibrosis with significantly lower levels of creatinine, urea, and potassium and higher urine output early after transplantation. IGF and better function of the right kidney was correlated with shorter time to reach a creatinine level of 2 mg%. In the postoperative periods, we also observed a difference between renal function depending on gender. The presence of acute tubular necrosis, arterial fibrosis, lack of inflammatory infiltration in the pre-0 biopsy correlated with worse late renal function. Among explantation biopsies 65.5% showed signs of CAN, and 37.93%, histologic marks of ARE.
许多因素会影响肾移植的长期结果，包括组织学损伤作为一个独立预测因素，如方案活检中的慢性移植肾/肾病以及年龄相关病变。组织病理学发现与移植肾功能延迟、肾功能及移植肾存活的发生率相关，从而能够较为精确地预测移植结果。
我们分析了92例肾移植前粗针活检及29例移植后活检标本。活检标本用4%甲醛固定并浸于石蜡中。理想的活检标本应包含至少10个肾小球及至少2个动脉横断面。我们分析了肾小管炎、急性肾小管坏死的程度、炎性浸润、肾小球肾炎、动脉玻璃样变、动脉炎、纤维化、肾小管萎缩、动脉内膜纤维化、系膜基质增加以及肾小球硬化的百分比。在术后过程中，我们分析了患者状况、术后透析的紧迫性、尿量以及血清肌酐、尿素、尿酸和离子浓度。在1年的观察期内，我们分析了活体受者、移植肾丢失、移植肾存活时的死亡情况、肾病（CAN）发生率及急性排斥反应（ARE）。
我们观察到即刻移植肾功能（IGF）与移植前0时活检中无急性肾小管坏死显著相关。我们未观察到肾功能与动脉玻璃样变、纤维化、炎性浸润、肾小管萎缩之间存在相关性。在术后阶段，我们观察到IGF与无间质纤维化显著相关，移植后早期肌酐、尿素和钾水平显著降低且尿量增加。IGF及右肾更好的功能与达到肌酐水平2mg%所需时间较短相关。在术后阶段，我们还观察到肾功能因性别而异。移植前0时活检中存在急性肾小管坏死、动脉纤维化、无炎性浸润与晚期肾功能较差相关。在移植后活检中，65.5%显示有CAN迹象，37.93%有ARE的组织学特征。
