移植肾功能延迟恢复病理组织学检查和临床分析报告

Pathologicl findings and clinical investingation on delayed graft function in renal

目的探讨移植肾功能延迟恢复(DGF)的病理学分析及防治措施。方法选取我院器官移植中心2007年12月至2010年9月肾移植术后患者84例为研究对象,其中32例为肾移植术后移植DGF,在B超引导下应用BARD(美国)活检穿刺针行移植肾穿刺活检,活检组织经石蜡包埋、切片后行常规苏木素-伊红(HE)染色,组织化学染色,同时常规行C4d免疫组织化学染色,依据Banff′05标准进行病理分型,通过移植肾的病理状态明确诊断,并进行相应的临床治疗,观察治疗效果。所有患者均顺利接受移植肾穿刺活检,穿刺后平卧4 h,予以抗炎止血治疗,无一例并发症出现。结果穿刺组织中,DGF的主要原因为急性肾小管坏死(ATN)20例,急性排斥反应(AR)8例,免疫抑制剂毒性肾损害4例。血液透析治疗31例,外科手术1例。31例DGF移植肾功能恢复正常,1例AR所致DGF最终切除移植肾,恢复规律血液透析。结论肾移植术后DGF是一种常见并发症,发生率高,ATN和AR是引起肾移植术后DGF的主要因素;具体情况选择适宜的血液净化方式,宜早不宜迟;在确定以血液净化为主的方案后,其他辅助措施亦为重要,绝大多数DGF可以恢复。

Objective To investigate the etiology,prevention and treatment of delayed graft function（DGF）in the recipients of renal transplantation.Methods Eighty-four renal allograft biopsies were performed.All biopsies were systematically diagnosed and evaluated according to the Banf 2005 schema.And 32 examples have delayed graft function（DGF） after kidney transplant,50 example have unknown elevated creatinine.In the B-ultrasonic guided application of BARD（United States） needle biopsy,slices were performed conventional dyeing with paraffin and HE staining.On the basis of Banff ＇ 05 standard histological pattern,the general C4d immunohistochemical staining was performed at the same time to make sure the renal transplant status and clear pathological diagnosis.Treatment effect was also observed after the clinical treatment accordingly.Results The renal functions were recovered normal in 32 cases;1 case caused by AR was removed of kidney and back to hemodialysis.Conclusion ATN and AR are the major reasons for DGF.It is important to match,screen recipients strictly and guarantee the quality of kidney for preventing DGF.