Ubhi C S, Baker J M, Guillou P J, Giles G R, Davison A M, Will E J
University Department of Surgery, St. James's University Hospital, Leeds, UK.
Nephrol Dial Transplant. 1988;3(4):453-7. doi: 10.1093/oxfordjournals.ndt.a091697.
The elective conversion of renal allograft recipients from cyclosporin (CsA) to azathioprine and prednisolone has the advantage that the long-term risk of CsA nephrotoxicity is reduced, but it may precipitate a rejection episode. We have monitored this period by fine-needle aspiration cytology (FNAC) in 24 patients undergoing conversion of immunosuppression 6 months after transplantation. As expected the serum creatinine and alkaline phosphatase were significantly reduced and the mean creatinine clearance was significantly increased after conversion. FNAC exhibited increased mononuclear cellular infiltration in 13 of the 24 patients. In nine patients there was a transient infiltration of lymphocytes and monocytes without changes in the normal parameters of renal function. In four others 'blast' cell infiltration was evident in association with rejection episodes. All four responded to pulsed doses of methylprednisolone. However, two other patients had late rejection episodes (2 and 6 months after conversion) which were steroid resistant and required reintroduction of CsA. No grafts were lost (median follow-up 9 months). This study has shown that although overt rejection occurred in only 16.6% of patients, cellular infiltration was present in over 50% during conversion of immunosuppression. FNAC failed to identify clearly the patients at risk of rejection during conversion of therapy.
将肾移植受者的免疫抑制剂从环孢素（CsA）选择性转换为硫唑嘌呤和泼尼松龙，具有降低CsA肾毒性长期风险的优势，但可能会引发排斥反应。我们通过细针穿刺细胞学检查（FNAC）对24例移植后6个月接受免疫抑制转换的患者进行了这一阶段的监测。正如预期的那样，转换后血清肌酐和碱性磷酸酶显著降低，平均肌酐清除率显著提高。FNAC显示24例患者中有13例单核细胞浸润增加。9例患者出现淋巴细胞和单核细胞短暂浸润，肾功能正常参数无变化。另外4例患者出现与排斥反应相关的“母细胞”浸润。所有4例患者对甲基泼尼松龙脉冲剂量治疗均有反应。然而，另外2例患者出现晚期排斥反应（转换后2个月和6个月），对类固醇耐药，需要重新使用CsA。无移植肾丢失（中位随访9个月）。这项研究表明，尽管只有16.6%的患者发生明显排斥反应，但在免疫抑制转换期间超过50%的患者存在细胞浸润。FNAC未能明确识别治疗转换期间有排斥反应风险的患者。
