Masin-Spasovska J, Spasovski G, Dzikova S, Petrusevska G, Lekovski Lj, Ivanovski N, Popov Z
Department of Nephrology, University Clinical Center, University of Skopje, Vodnjanska 17, 1000 Skopje, R. Macedonia.
Transplant Proc. 2007 Oct;39(8):2550-3. doi: 10.1016/j.transproceed.2007.08.023.
The aim of the present study was to evaluate whether treatment of subclinical, borderline rejections (SR/BR) or histological findings of chronic allograft nephropathy (CAN) in protocol biopsies in the first month posttransplantation after living related kidney transplantation has a beneficial effect on graft histology and renal function at 6 months. Among the 40 paired biopsies, only 6/80 showed no histological lesions. BR was found in 13/40 and 12/40, and SR in 15/40 and 21/40 of patients on the 1- and 6-month biopsies, respectively. The mean histological index/total sum of scores for acute and chronic changes (HI) increased at 6-month biopsy: 5.3 +/- 2.9 vs 7.8 +/- 3.6 (P < .001). Similarly, the mean sum of histological markers for chronicity (CAN score) of 2.1 +/- 1.5 increased to 4.6 +/- 2.3 (P < .001) on the 6-month biopsy. When divided according to whether there was treatment of BR and SR, the treated BR/SR group on 1-month biopsy had a mean HI score of 7.11 +/- 1.9, which remained almost the same (7.11 +/- 2.32) at 6 months. Among the untreated BR/SR group it increased from 4.95 +/- 1.99 to 8.16 +/- 4.30. However, there was no difference in graft function between the groups from 1 to 6 months. In conclusion, a protocol 1-month biopsy may be valuable to establish the prevalence of BR/SR in stable allografts. The presence of an untreated BR/SR upon a 1-month biopsy showed greater susceptibility for histological deterioration on the 6-month biopsy due to an accelerated CAN process.
本研究的目的是评估在亲属活体肾移植术后第一个月的方案活检中，对亚临床、临界排斥反应（SR/BR）或慢性移植肾肾病（CAN）的组织学表现进行治疗，是否对6个月时的移植肾组织学和肾功能有有益影响。在40对活检样本中，只有6/80未显示组织学病变。在1个月和6个月活检时，分别有13/40和12/40的患者发现临界排斥反应，15/40和21/40的患者发现亚临床排斥反应。6个月活检时，急性和慢性变化的平均组织学指数/总分（HI）增加：5.3±2.9对比7.8±3.6（P<.001）。同样，6个月活检时，慢性病变（CAN评分）的组织学标志物平均总分从2.1±1.5增加到4.6±2.3（P<.001）。根据是否对临界排斥反应和亚临床排斥反应进行治疗进行分组时，1个月活检时接受治疗的临界排斥反应/亚临床排斥反应组的平均HI评分为7.11±1.9，6个月时几乎保持不变（7.11±2.32）。在未治疗的临界排斥反应/亚临床排斥反应组中，该评分从4.95±1.99增加到8.16±4.30。然而，1至6个月期间，两组间的移植肾功能没有差异。总之，1个月的方案活检对于确定稳定移植肾中临界排斥反应/亚临床排斥反应的发生率可能有价值。1个月活检时存在未治疗的临界排斥反应/亚临床排斥反应，表明由于CAN进程加速，6个月活检时组织学恶化的易感性更高。
