Rossmann P, Jirka J, Zástava V, Reneltová I, Kocandrle V
Zentralbl Allg Pathol. 1986;132(5-6):435-58.
During 1983 to 1986 41 patients were treated with Cyclosporin A (CyA) following kidney allotransplantation (TPL). 31 received the first (29 extra- and 2 intrafamilial) graft; in 10 there was second TPL, in 9 cases under high-risk conditions, where the first graft had been destroyed by (hyper)acute rejection or by rapidly progressive rejection with early vascular lesion. 21 needle biopsies and 5 excised grafts which had been collected 5 days to 18 months after TPL were examined by light microscopy and in addition 6 of the former also underwent electron and immunofluorescence microscopic study. The glomeruli showed discrete, inconstant segmental lesions but the ultrastructure also revealed severe general endothelial swelling. The tubular system had nonspecific degenerative changes of varying extent. In 11 patients focal cytoplasmic microvacuoles appeared in proximal tubular epithelia; there were also inconstant hyaline droplets, microcalcifications, and intratubular crystals. Electron microscopy revealed multiple round dense intramitochondrial inclusions in proximal tubules. The ultrastructure of the microvacuoles resembled that of "osmotic nephropathy". The rejection infiltrate and interstitial fibrosis of various degree did not essentially differ from those of conventionally treated grafts. In 7 patients cortical arterioles and small arteries exhibited a stenosing lesion (toxic?). In 3 cases metachromatic "mucoid" thickening of intima was prominent. Ultrastructure studies showed swollen endothelial cells with numerous globular dense bodies and a severe defect in the leiomyofibrils of muscle cells of the media. Hyperplasia of juxtaglomerular apparatus was apparent in 7 patients. Immunofluorescent microscopy of two biopsies from subsequently excised grafts visualized IgM, C3, and fibrinogen in small arteries and some glomerular capillary loops. Three early nephrectomies were caused by infarct-like necrosis. The discussion deals with differences between CyA- and conventionally treated grafts, diagnostic features, interpretation of findings, and measures following biopsy. In our patients with continual CyA-treatment no case of clinically and morphologically typical obliterative arterio-arteriolopathy (OA) and rapidly progressive irreversible rejection has as yet been noted.
1983年至1986年期间，41例患者在肾移植后接受环孢素A（CyA）治疗。31例接受首次（29例为非亲属供肾及2例亲属供肾）移植；10例接受第二次肾移植，其中9例处于高危状态，首次移植因（超）急性排斥反应或伴有早期血管病变的快速进行性排斥反应而被破坏。对21例针吸活检标本及5例移植后5天至18个月切除的移植肾进行了光镜检查，另外，对其中6例针吸活检标本还进行了电镜及免疫荧光显微镜检查。肾小球呈现离散的、不恒定的节段性病变，但超微结构也显示出严重的广泛性内皮细胞肿胀。肾小管系统有不同程度的非特异性退行性改变。11例患者近端肾小管上皮细胞出现局灶性胞质微泡；还可见不恒定的玻璃样小滴、微钙化及管腔内结晶。电镜显示近端肾小管线粒体中有多个圆形致密的线粒体内包涵体。微泡的超微结构类似于“渗透性肾病”。排斥浸润及不同程度的间质纤维化与传统治疗的移植肾基本无差异。7例患者皮质小动脉和小动脉出现狭窄性病变（毒性？）。3例内膜出现异染性“黏液样”增厚。超微结构研究显示内皮细胞肿胀，有许多球形致密小体，中膜肌细胞的平滑肌原纤维有严重缺陷。7例患者肾小球旁器增生明显。对随后切除的移植肾的两份活检标本进行免疫荧光显微镜检查，可见小动脉及一些肾小球毛细血管袢中有IgM、C3和纤维蛋白原。3例早期肾切除是由梗死样坏死所致。讨论涉及CyA治疗与传统治疗的移植肾之间的差异、诊断特征、检查结果的解释以及活检后的措施。在我们持续接受CyA治疗的患者中，尚未发现临床及形态学上典型的闭塞性小动脉-小动脉病（OA）及快速进行性不可逆排斥反应的病例。
