小叶间透明样动脉病反映了肾移植中严重的小动脉病变。

Interlobular hyaline arteriopathy reflects severe arteriolopathy in renal allografts.

作者信息

Oguchi Hideyo, Sakai Ken, Yamaguchi Yutaka, Mikami Tetuo, Nemoto Tetsuo, Ohashi Yasushi, Kawamura Takeshi, Muramatsu Masaki, Itabashi Yoshihiro, Shinoda Kazunobu, Hyodo Yoji, Takahashi Yusuke, Kawaguchi Yuki, Onishi Hiroka, Hamasaki Yuko, Shibuya Kazutoshi, Shishido Seiichiro

机构信息

Department of Nephrology, Toho University Faculty of Medicine, Tokyo, Japan.

Yamaguchi's Pathology Laboratory, Chiba, Japan.

出版信息

Nephrology (Carlton). 2018 Jul;23 Suppl 2:58-62. doi: 10.1111/nep.13275.

DOI:10.1111/nep.13275

PMID:29968404

Abstract

AIM

The present study was performed to examine the clinicopathological significance of hyaline deposits in the smooth muscle of the interlobular artery (interlobular hyaline arteriopathy [IHA]) in renal allografts.

METHODS

Tissue specimens that included the interlobular artery from biopsies performed from January 2012 to December 2015, as well as specimens from biopsies performed ≥1 year after living kidney transplantation were analyzed. Biopsies of recipients with new-onset diabetes mellitus after transplantation were excluded, as well as those of recipients who had undergone transplantation because of diabetic nephropathy. Arteriolopathy was evaluated using the aah score determined by the Banff 2007 classification.

RESULTS

In total, 51 specimens with IHA lesions were identified among 381 biopsies obtained from 243 recipients performed ≥1 year after kidney transplantation. Among these 51 biopsies, 18 specimens had a score of aah3, 29 had a score of aah2, and four had a score of aah1. The incidence of IHA lesions was 3.6% at ≥1 to <4 years, 18.5% at ≥4 to <8 years, and 54.1% at ≥8 years. Older kidney grafts exhibited more IHA lesions. Among the biopsy specimens obtained ≥8 years after transplantation, no significant differences in the recipient or donor age, duration after transplantation, or prevalence of hypertension were observed between the IHA and non-IHA groups. The aah scores were significantly higher in the IHA group ≥8 years after transplantation as determined by the mean score test (P < 0.01).

CONCLUSION

IHA in renal allografts is associated with severe arteriolopathy.

摘要

目的

本研究旨在探讨肾移植中肾小叶间动脉平滑肌内透明样沉积物（小叶间透明样动脉病[IHA]）的临床病理意义。

方法

分析2012年1月至2015年12月期间活检获取的包含肾小叶间动脉的组织标本，以及活体肾移植术后≥1年的活检标本。排除移植后新发糖尿病患者的活检标本，以及因糖尿病肾病接受移植患者的活检标本。使用Banff 2007分类法确定的aah评分评估动脉病。

结果

在243例肾移植术后≥1年的受者所获取的381份活检标本中，共鉴定出51份有IHA病变的标本。在这51份活检标本中，18份标本aah评分为3分，29份为2分，4份为1分。IHA病变的发生率在≥1至<4年时为3.6%，≥4至<8年时为18.5%，≥8年时为54.1%。移植肾龄越大，IHA病变越多。在移植术后≥8年获取的活检标本中，IHA组与非IHA组在受者或供者年龄、移植后时间或高血压患病率方面未观察到显著差异。通过均值评分检验确定，移植术后≥8年时IHA组的aah评分显著更高（P<0.01）。