Wilkinson Alan
David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1693, USA.
Clin J Am Soc Nephrol. 2006 Jan;1(1):130-7. doi: 10.2215/CJN.00350705. Epub 2005 Nov 9.
Studies suggest that surveillance or protocol biopsies that are performed during the first year after kidney transplantation may be clinically useful in identifying early acute rejection or chronic allograft nephropathy at a point when they may be amenable to treatment. Although the benefit of this approach has yet to be evaluated in large, multicenter, prospective trials, numerous studies suggest that implementation of protocol biopsies may improve long-term graft function. In particular, a number of reports suggest that detection of chronic allograft nephropathy in early protocol biopsies is predictive of subsequent graft function and loss and that early treatment may have a dramatic effect on the outcome of the graft. Protocol biopsies also have the potential to be of great value in high-risk patients, such as those with delayed graft function, by allowing for early intervention for acute rejection. Furthermore, the procedure seems to be relatively straightforward and safe. Nevertheless, paucity of data has meant that clear proof of a benefit of early treatment of subclinical rejection and chronic allograft nephropathy detected by protocol biopsy is lacking. Moreover, the optimal timing of protocol biopsies and reliable methods to quantify the histologic changes observed in biopsy specimens have yet to be determined. This review discusses the pros and cons of protocol biopsies and considers the place of this procedure in the routine treatment of kidney transplant patients.
研究表明，在肾移植后的第一年进行监测性活检或方案性活检，在识别早期急性排斥反应或慢性移植肾肾病方面可能具有临床意义，此时这些病症或许适合进行治疗。尽管这种方法的益处尚未在大型、多中心、前瞻性试验中得到评估，但众多研究表明，实施方案性活检可能会改善移植肾的长期功能。特别是，一些报告表明，在早期方案性活检中检测到慢性移植肾肾病可预测随后的移植肾功能和丧失情况，而且早期治疗可能会对移植肾的预后产生显著影响。方案性活检对于高危患者，如移植肾功能延迟恢复的患者，也有可能具有重大价值，因为它能够对急性排斥反应进行早期干预。此外，该操作似乎相对简单且安全。然而，数据的匮乏意味着缺乏通过方案性活检检测到的亚临床排斥反应和慢性移植肾肾病进行早期治疗有益的明确证据。而且，方案性活检的最佳时机以及量化活检标本中观察到的组织学变化的可靠方法尚未确定。本综述讨论了方案性活检的利弊，并考虑了该操作在肾移植患者常规治疗中的地位。
