Department of Renal Medicine, Westmead Hospital, University of Sydney, Australia.
Am J Transplant. 2011 Aug;11(8):1570-5. doi: 10.1111/j.1600-6143.2011.03677.x.
Protocol renal allograft biopsies at fixed time points from transplantation have aided research and provided insights into the pathogenesis of early and late allograft injury. Their role is evolving from research to a clinical management tool needed to detect subclinical pathology requiring treatment adjustment. They frequently reveal unexpected findings and influence therapy in the majority of patients. Detection of subclinical rejection (SCR) remains important despite declining prevalence with triple therapy, the evidence favors treatment, if found. Surveillance biopsies in steroid avoidance and calcineurin inhibitor (CNI) withdrawal programs provide an important safety net against the increased rates of late acute and SCR. Individualization of therapy in high-risk patients and safe reduction of immunosuppression in standard risk individuals becomes possible. Other potentially reversible chronic pathologies that may be detected, include chronic T-cell or antibody-mediated rejection, recurrent disease, BK virus-associated nephropathy, interstitial fibrosis and tubular atrophy and CNI nephrotoxicity, allowing modifications of therapy to limit ongoing graft injury. Biopsy is safe and inexpensive compared with costs of earlier graft failure and return to dialysis. This review summarizes current evidence on use of surveillance histology for the clinical practice of renal transplantation.
移植后定期进行的肾移植组织学活检有助于研究，并深入了解早期和晚期移植物损伤的发病机制。其作用正从研究工具演变为临床管理工具，用于检测需要调整治疗的亚临床病变。它们经常揭示出意想不到的发现，并影响大多数患者的治疗。尽管三联疗法使亚临床排斥反应 (SCR) 的发生率降低，但检测 SCR 仍然很重要，如果发现 SCR，仍建议进行治疗。在类固醇回避和钙调神经磷酸酶抑制剂 (CNI) 停药方案中的监测活检为晚期急性排斥反应和 SCR 的发生率增加提供了重要的安全网。在高危患者中进行个体化治疗，并在标准风险患者中安全减少免疫抑制，成为可能。其他可能被检测到的潜在可逆性慢性病变，包括慢性 T 细胞或抗体介导的排斥反应、复发性疾病、BK 病毒相关性肾病、间质纤维化和肾小管萎缩以及 CNI 肾毒性，允许调整治疗以限制持续的移植物损伤。与早期移植物失功和恢复透析的成本相比，活检既安全又便宜。本文综述了监测组织学在肾移植临床实践中的应用的现有证据。
