Nephrology Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Iran J Kidney Dis. 2023 May;17(3):168-173.
Despite many advances in the development of knowledge and application of new immunosuppressive medications over the past two decades, the improvement has only been seen in the short-term outcome of kidney transplantation while the long-term survival of kidney transplantation has not significantly improved. Allograft kidney biopsy may help to determine the causes of allograft dysfunction which may change the treatment strategy.
In this retrospective study, kidney transplant recipients who underwent kidney biopsy in Shariati hospital during the years 2004 to 2015, at least three months after the kidney transplantation, were included for evaluation. Chi-square, ANOVA, post-hoc LSD, and T-test were used for data analysis.
A total number of 525 renal transplant biopsies were performed; 300 of them had complete medical records. The reported pathologies consisted of acute T-Cell mediated rejection (TCMR) (17%), interstitial fibrosis and tubular atrophy/chronic allograft nephropathy (IFTA/CAN) (15%), calcineurin inhibitor (CNI) nephrotoxicity (12.8%), borderline changes (10.3%), glomerulonephritis (GN) (8.9%), antibody mediated rejection (ABMR) (6.7%), transplant glomerulopathy (TG) (5.3%), normal (8.4%), and other pathologies (15.6%). C4d was positive in 19.9% of the biopsies. The pathology category had a significant correlation with allograft function (P < .001), but it had no significant relationship with age and gender of the recipient, donor and donor source (P > .05). Moreover, in about 50% of cases, treatment interventions were based on pathological results, which were effective in 77% of cases. The two-year graft and patient survival after kidney biopsy were 89% and 98%, respectively.
Acute TCMR, IFTA/CAN, CNI nephrotoxicity were the most common causes of allograft dysfunction based on the transplanted kidney biopsy. In addition, pathologic reports were helpful for proper treatment. DOI: 10.52547/ijkd.7256.
尽管在过去的二十年中，在知识的发展和新免疫抑制剂药物的应用方面取得了许多进展，但肾移植的短期结果有所改善，而肾移植的长期存活率并没有显著提高。同种异体肾活检有助于确定同种异体肾功能障碍的原因，这可能会改变治疗策略。
在这项回顾性研究中，纳入了 2004 年至 2015 年在沙里亚特医院接受肾活检的肾移植受者，至少在肾移植后三个月进行评估。使用卡方检验、方差分析、事后 LSD 和 T 检验进行数据分析。
共进行了 525 例肾移植活检，其中 300 例有完整的病历。报告的病理包括急性 T 细胞介导的排斥反应（TCMR）（17%）、间质纤维化和小管萎缩/慢性移植肾肾病（IFTA/CAN）（15%）、钙调神经磷酸酶抑制剂（CNI）肾毒性（12.8%）、边缘性改变（10.3%）、肾小球肾炎（GN）（8.9%）、抗体介导的排斥反应（ABMR）（6.7%）、移植肾小球病（TG）（5.3%）、正常（8.4%）和其他病变（15.6%）。活检中 C4d 阳性率为 19.9%。病理类别与同种异体肾功能有显著相关性（P<0.001），但与受者、供者和供者来源的年龄和性别无显著关系（P>0.05）。此外，在大约 50%的病例中，治疗干预措施是基于病理结果的，其中 77%的病例有效。肾活检后 2 年的移植物和患者存活率分别为 89%和 98%。
急性 TCMR、IFTA/CAN、CNI 肾毒性是基于移植肾活检的同种异体肾功能障碍的最常见原因。此外，病理报告有助于进行适当的治疗。DOI：10.52547/ijkd.7256.
