Malathi C V, Jansi Prema K S, Kurien Anila Abraham
Department of Pathology, Renopath Center for Renal and Urological Pathology, Chennai, Tamil Nadu, India.
Indian J Nephrol. 2024 Nov-Dec;34(6):617-622. doi: 10.25259/IJN_73_2024. Epub 2024 Jul 22.
Though infrequent, allograft nephrectomies are performed for early and late graft loss. The study aims to analyze the histopathologic characteristics of allograft nephrectomy specimens.
We conducted an observational study of 103 cases of allograft nephrectomies from 21 centers from 2013 to 2023. All the pathology slides, including hematoxylin and eosin-stained sections, masson trichrome, jones methenamine silver, PAS, GMS, AFB, and immunohistochemistry (C4d, SV40) were reviewed. Pathologic findings were analyzed based on the transplant to nephrectomy interval (0-3 months, > 3 months) and type of donor (deceased, live donor).
Of the total 103 cases, 77 were male. The mean age at the time of nephrectomy was 36.4 (range 5-64) years. The allografts were obtained from deceased (57) donors and live related (46) donors. Graft tenderness, oliguria/anuria, and fever were common clinical presentations. The majority (71.8%) of the nephrectomies were performed within the first 3 months of renal transplant. Renal vessel thrombosis (32.03%) was the most common pathologic finding. Infections were more common in the first 3 months after the transplant. Fungal infection had a significant association with deceased donor transplantation (p = 0.029).
Histopathological study of allograft nephrectomy specimens aids understanding of graft loss causes. The study also provides opportunities to prevent complications and implement measures to prolong graft survival in a subsequent transplant.
尽管同种异体肾切除术并不常见，但仍用于早期和晚期移植肾丢失的情况。本研究旨在分析同种异体肾切除标本的组织病理学特征。
我们对2013年至2023年来自21个中心的103例同种异体肾切除术进行了观察性研究。回顾了所有病理切片，包括苏木精和伊红染色切片、马松三色染色、琼斯甲萘胺银染色、PAS染色、GMS染色、抗酸染色以及免疫组织化学（C4d、SV40）。根据移植至肾切除的间隔时间（0 - 3个月、>3个月）和供体类型（已故、活体供体）对病理结果进行分析。
在总共103例病例中，77例为男性。肾切除时的平均年龄为36.4岁（范围5 - 64岁）。移植肾来自已故供体（57例）和活体亲属供体（46例）。移植肾压痛、少尿/无尿和发热是常见的临床表现。大多数（71.8%）肾切除术在肾移植后的前3个月内进行。肾血管血栓形成（32.03%）是最常见的病理表现。感染在移植后的前3个月更为常见。真菌感染与已故供体移植有显著关联（p = 0.029）。
同种异体肾切除标本的组织病理学研究有助于了解移植肾丢失的原因。该研究还为预防并发症以及在后续移植中采取措施延长移植肾存活提供了机会。
