Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria.
Nephrol Dial Transplant. 2012 Aug;27(8):3241-8. doi: 10.1093/ndt/gfs066. Epub 2012 Apr 6.
The assessment of donor-derived damage of transplanted kidneys might be instrumental for estimating donor organ quality and for predicting short- and long-term organ outcome. In the present study, we report a new standardized method for obtaining pre-transplant kidney biopsy specimens. Instead of taking wedge biopsies (WBs), a skin punch biopsy (PB) tool was utilized to obtain standardized biopsy samples that also represented deeper cortical zones.
We compared 147 PB specimens and 114 WBs with respect to the number of glomeruli and arterial vessels they contained. The performance of the two biopsy methods in detecting glomerular damage, interstitial fibrosis/tubular atrophy (IF/TA) and arteriosclerosis was determined by evaluation of subsequent transplant core biopsies of the patients. Statistical comparison employed Kruskal-Wallis and kappa (κ) tests.
Significantly more PB samples (89%) than WBs (66%) were diagnostically adequate according to the Banff criteria. Despite a higher number of glomeruli in WBs (34.6 versus 21.7 in punch biopsies), arteries were present in only 68% of WBs but could be found in 93% of punch biopsies. The comparison of findings in pre-transplant biopsies with lesions in corresponding post-transplant core biopsies revealed a superior diagnostic concordance for IF/TA and arteriosclerosis for punch biopsies than for WBs, reaching kappa values of 0.823 versus 0.729 and 0.661 versus 0.516, respectively.
The use of skin PB tools for obtaining baseline biopsies from transplanted kidneys is a safe and effective method for assessment of donor-derived damage of the organ.
评估移植肾脏的供体损伤可能有助于评估供体器官质量，并预测短期和长期器官预后。在本研究中，我们报告了一种获得移植前肾活检标本的新标准化方法。我们使用皮肤活检工具（而非楔形活检）获取标准化活检样本，这些样本也代表了更深的皮质区。
我们比较了 147 例皮肤活检样本和 114 例楔形活检样本中包含的肾小球和动脉数量。通过评估患者随后的移植核心活检，确定两种活检方法在检测肾小球损伤、间质纤维化/肾小管萎缩（IF/TA）和动脉硬化方面的性能。统计比较采用 Kruskal-Wallis 和 kappa（κ）检验。
根据 Banff 标准，诊断性足够的皮肤活检样本（89%）明显多于楔形活检样本（66%）。尽管楔形活检中的肾小球数量更多（34.6 个比穿刺活检中的 21.7 个），但只有 68%的楔形活检中存在动脉，而 93%的穿刺活检中存在动脉。与相应移植后核心活检中的病变相比，移植前活检中的发现比较显示，穿刺活检在 IF/TA 和动脉硬化方面的诊断一致性优于楔形活检，κ 值分别为 0.823 比 0.729 和 0.661 比 0.516。
使用皮肤穿刺活检工具获取移植肾脏的基线活检是一种安全有效的方法，可用于评估器官的供体损伤。
