Department of Nephrology, Radboud university medical center, Nijmegen, The Netherlands.
Department of Pathology, Radboud university medical center, Nijmegen, The Netherlands.
Transpl Int. 2020 Dec;33(12):1693-1699. doi: 10.1111/tri.13724. Epub 2020 Oct 13.
The incidence and relevance of histological findings in removed allografts is unknown. In this study, we investigated the outcome of routine histopathological examination of removed allografts. We performed a retrospective cohort study in patients with kidney graft failure ≥3 months after transplantation. In this cohort, 244 allograft nephrectomies were performed. We routinely sent removed grafts for histopathological examination. In 197 cases, a pathology report was available for analysis. In 21 of the 197 grafts, gross necrosis precluded adequate interpretation. Signs of rejection were reported in 163 of the remaining 176 allografts. Recurrences of the original disease were found in 13 cases. These were all known from prior biopsies. Relevant secondary findings were present in eight cases: renal cell carcinoma (n = 2), urothelial cell carcinoma, candida pyelonephritis (n = 2), post-transplant lymphoproliferative disease, polyomavirus inclusions, and membranous nephropathy. All conditions were diagnosed before graft nephrectomy, except for one case of papillary renal cell carcinoma of 0.8 cm. As expected, signs of acute and/or chronic rejection are the main histopathological finding in grafts that are removed after late graft failure. Unexpected secondary findings are very rare. Therefore, it is justifiable to restrict histopathological examination of removed kidney allografts to specific cases.
移植后 3 个月以上发生移植物失功的患者中，我们研究了常规组织病理学检查移除移植物的结果。我们对这些患者进行了回顾性队列研究。在该队列中，我们进行了 244 例移植肾切除术。我们常规将移除的移植物送检进行组织病理学检查。在 197 例中，有病理学报告可供分析。在 197 例移植物中，有 21 例因大体坏死而无法进行充分解读。在其余 176 例移植物中，有 163 例报告有排斥反应的迹象。在 13 例中发现了原发病的复发，这些均来自之前的活检。在 8 例中发现了相关的次要发现：肾细胞癌（n=2）、尿路上皮细胞癌、假丝酵母菌肾盂肾炎（n=2）、移植后淋巴组织增生性疾病、多瘤病毒包涵体和膜性肾病。除了 1 例 0.8cm 的乳头状肾细胞癌外，所有这些情况均在移植肾切除术前诊断。正如预期的那样，在晚期移植物失功后移除的移植物中，主要的组织病理学发现是急性和/或慢性排斥反应的迹象。罕见发现意外的次要发现。因此，将移除的肾移植物的组织病理学检查仅限于特定病例是合理的。
