Kidney allograft biopsy: Pathological and histological values in early diagnosis

doi:10.3969/j.issn.2095-4344.2013.05.004

Abstract

Abstract:

BACKGROUND: The kidney allograft biopsy has great pathological and histological significance in the early diagnosis. However, the retrospective study of clinical diagnosis and treatment is rare.
OBJECTIVE: To observe the effect of clinical treatments selected according to the pathological diagnosis which obtained through the wellness puncture biopsy on insufficiency renal allograft, and to identify the security and significance of grafted renal puncture biopsy in the clinical treatment. 　
METHODS: 202 patients with renal transplantation were selected from the Organ Transplant Center, the 309th Hospital of Chinese PLA. Among them, 80 patients with delayed recovery of kidney function after kidney transplantation and 122 patients were found increasing creatinine content without explanation. With the guidance of B-ultrasound, a puncture needle was used to perform the kidney allograft biopsy, and the biopsy specimens were stained and histopathologically by observed for the corresponding clinical treatment.
RESULTS AND CONCLUSION: All the patients were well accepted by biopsy, except three patients (1.5%) were difficult to be diagnosed because of less tissue. Twelve patients (5.9%) had normal graft kidney, 28 patients (13.9%) suffered from ischemia/reperfusion injury combined with acute tubular necrosis, 22 patients (10.9%) appeared with mild acute toxic injury caused by calcium calcineurin inhibitor immunosuppressive drugs, 12 patients (5.9%) had mild chronic toxic injury caused by calcium calcineurin inhibitor immunosuppressive drugs, one patient (0.5%) appeared with hyperacute rejection, 29 patients (14.4%) were doubted with acute rejection, 34 patients (16.8%) suffered with acute T-cell rejection, 10 patients (9.4%) appeared with acute antibody-mediated rejection, 16 patients (7.9%) appeared with chronic T cell-mediated rejection, 12 patients (5.9%) suffered from chronic T cell-mediated rejection combined with acute T cell-mediated rejection, three patients (1.5%) displayed chronic antibody-mediated rejection, four patients (2.0%) showed hypertension and related factors, two patients (1.0%) suffered from interstitial fibrosis and tubular atrophy without specific risk factors caused lesions, two patients (1.0%) presented with ischemic necrosis, three patients (1.5%) presented with nephropathy recurrence after transplantation and 23 patients were positive for C4d immunohistochemical staining. No adverse reaction was found in the patients or in the graft kidney.

Key words: organ transplantation, renal transplantation, transplant renal biopsy, biopsy, needle aspiration, pathological biopsy, diagnosis, treatment, other grants-supported paper, photographs-containing paper of organ transplantation

CLC Number:

R318

Han Yong, Guo Hui, Cai Ming, Xu Xiao-guang, Huang Hai-yan, Xu Yan-jie, Wang Qiang, Feng Kai, Shi Bing-yi. Kidney allograft biopsy: Pathological and histological values in early diagnosis[J]. Chinese Journal of Tissue Engineering Research, 2013, 17(5): 785-790.

Figures/Tables 1

2.1 病理结果 202例患者总共进行穿刺400次，穿刺时间为接受肾移植后3 d-10年不等，大部分患者在肾移植后4周内进行。每个标本取得的有效肾小球组织为8-24个，平均为15个。有3例患者因为肾移植术后时间较长且肾皮质变薄，未能取得充足的有效组织进行病理检查。穿刺组织中，病理诊断移植肾正常12例(5.9%)，疑为急性T细胞介导排斥反应29例(14.4%)和急性T细胞介导性排斥反应34例(16.8%)，其病理诊断观察到多数急性T细胞介导性排斥反应表现为散在弥漫性淋巴细胞浸润及肾小管上皮炎，见图1a。缺血再灌注损伤合并(或)急性肾小管坏死28例(13.9%)，其病理特征性变化为肾小管上皮细胞刷状缘消失、细胞胞核消失，再生肾小管上皮细胞常呈多层叠加于肾小管基膜上，见图1b。轻度钙调磷酸酶抑制剂类免疫抑制剂急性毒性损伤22例(10.9%)和轻度钙调磷酸酶抑制剂类免疫抑制剂慢性毒性损伤12例(5.9%)，主要为肾小管上皮细胞内细小等大空泡样改变和入球微动脉空泡样变，见图1c。慢性毒性损伤常发生在肾移植后１年以上，主要表现在活检组织内入球微动脉管壁局部透明变性，肾组织间质内条带状纤维化，见图1d。慢性T细胞介导排斥反应16例(7.9%)和慢性抗体介导性排斥反应3例(1.5%)，表现为肾小球缺血性皱缩乃至硬化，肾小管片状萎缩和消失，间质弥漫性或条索状纤维化，各级动脉壁增厚，内膜纤维化，管腔狭窄甚至闭塞，见图1e。急性抗体介导性排斥反应19例(9.4%)，表现与急性T细胞介导性排斥反应组织学表现类似，如果不进行C4d免疫组织化学染色则难以鉴别诊断，见图1f。慢性抗体介导性排斥反应，C4d免疫组化染色肾小管毛细血管内皮(PTC)阳性；不明原因缺血性坏死和以入球微动脉明显透明样变表现的高血压相关因素移植肾损伤等罕见，见图1g，h。超急性排斥反应1例(0.5%)，慢性T细胞介导排斥反应伴急性T细胞介导性排斥反应12例(5.9%)，高血压因素4例(2.0%)，间质纤维化和肾小管萎缩。未发现特定致病因素所致病变2例(1.0%)，缺血性坏死2例(1.0%)，移植后肾病复发3例(1.5%)，C4d免疫组化染色阳性23例(11.4%)。移植肾组织活检的病理报告与穿刺前临床诊断的符合率在80%以上。 2.2 治疗结果分别采用类固醇激素静脉冲击、兔抗人胸腺细胞免疫球蛋白静脉冲击、减少免疫抑制剂和其他辅助药物剂量、全身支持治疗同时观察等待、抗CD20单克隆抗体静脉治疗等多种方式，202例患者中166例移植血清肌酐均呈不同程度的下降，肾功能均得以恢复，31例移植肾肌酐稳定于较高水平，5例移植肾失功，切除。"

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