Waltzer W C, Miller F, Arnold A, Anaise D, Rapaport F T
Transplantation. 1987 Jan;43(1):100-5. doi: 10.1097/00007890-198701000-00022.
The value of percutaneous core needle biopsy in the immunohistological evaluation of renal allograft dysfunction was studied in 72 consecutive biopsies performed in 42 patients. The phenotypes of infiltrating cells mediating graft destruction were identified with monoclonal antibodies and immunoperoxidase staining techniques. Light microscopy, electron microscopy, and immunofluorescence staining were performed in all biopsies. Biopsies were divided into groups depending on their classification on the basis of standard histologic criteria, i.e., acute tubular necrosis (ATN), acute interstitial rejection, acute vascular rejection, chronic rejection and renal disease in native kidneys (RDNK) of nontransplant patients. Immunohistologic analysis of graft biopsies showed a significant increase in Leu 1 (pan-T cells), (P less than 0.001), Leu 2 (cytotoxic/suppressor cells) (P less than 0.001), and Leu 3 cells (P less than .05) in acute interstitial rejection. The expression of DR antigen was significantly increased in both acute (P less than .025) and chronic (P less than .05) rejection, when compared with the findings in ATN biopsies. Leu M1 (monocytes/activated T cells) and Leu 10 (B cells/macrophages) were significantly increased (P less than 0.05 and P less than .005, respectively) in acute interstitial rejection only. The helper/suppressor ratio of infiltrating cells showed no significant change in any clinopathologic category. There was no correlation between the cell populations infiltrating the graft and those monitored in the peripheral blood. Allograft mononuclear cell infiltrates in cyclosporine (CsA) vs. azathioprine-treated patients revealed significantly fewer Leu 2 (P less than .05) and Leu M1 (P less than .05) cell populations in CsA patients during acute rejection. In 32 of these 72 biopsies (44.4%), the biopsy results provided a direct contraindication to the use of steroids, by allowing differentiation between allograft rejection and other causes of graft dysfunction. A total of 38% of the biopsies yielded a histological diagnosis that contradicted the clinical pre-biopsy diagnosis. All allografts showing evidence of severe small vessel disease and/or antibody-mediated rejection eventually were lost. These data highlight the usefulness of needle biopsy material as a guide to the study of intragraft immune events and to clinical management of recipients.
对42例患者连续进行的72次活检研究了经皮芯针活检在肾移植功能障碍免疫组织学评估中的价值。使用单克隆抗体和免疫过氧化物酶染色技术鉴定介导移植物破坏的浸润细胞的表型。所有活检均进行光镜、电镜和免疫荧光染色。根据标准组织学标准对活检进行分类，即急性肾小管坏死（ATN）、急性间质排斥、急性血管排斥、慢性排斥以及非移植患者的自身肾疾病（RDNK），并据此分组。对移植物活检的免疫组织学分析显示，急性间质排斥中Leu 1（全T细胞）显著增加（P<0.001）、Leu 2（细胞毒性/抑制性细胞）显著增加（P<0.001）以及Leu 3细胞显著增加（P<0.05）。与ATN活检结果相比，DR抗原的表达在急性（P<0.025）和慢性（P<0.05）排斥中均显著增加。Leu M1（单核细胞/活化T细胞）和Leu 10（B细胞/巨噬细胞）仅在急性间质排斥中显著增加（分别为P<0.05和P<0.005）。浸润细胞的辅助/抑制比在任何临床病理类别中均无显著变化。移植物中浸润的细胞群体与外周血中监测的细胞群体之间无相关性。在急性排斥期间，环孢素（CsA）治疗组与硫唑嘌呤治疗组的移植物单核细胞浸润显示，CsA治疗组的Leu 2细胞群体（P<0.05）和Leu M1细胞群体（P<0.05）显著减少。在这72次活检中的32次（44.4%），活检结果通过区分移植物排斥和移植物功能障碍的其他原因，为使用类固醇提供了直接的禁忌证。总共38%的活检得出的组织学诊断与活检前的临床诊断相矛盾。所有显示严重小血管疾病和/或抗体介导排斥证据的移植物最终均丢失。这些数据突出了针吸活检材料在研究移植物内免疫事件和指导受者临床管理方面的有用性。
