移植肾穿刺病理组织中抗体介导的排斥反应

Antibody mediated rejection during transplant kidney biopsy

背景:体液性排斥以激素耐受和难治性为其显著的特点,常常发生在免疫高敏的受者身上。目的:对肾功能不全移植肾进行常规穿刺病理活检,根据病理诊断观察抗体介导性排斥反应的治疗效果,分析移植肾穿刺病理活检的安全性。方法:选取肾移植后有移植肾穿刺活检指征的患者84例,在B超引导下应用BARD(美国)活检穿刺针行移植肾穿刺活检,活检组织行常规苏木精-伊红染色,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,根据病理状态明确诊断进行相应的临床治疗,观察治疗效果。结果与结论:84例患者除1例由于组织少难以诊断,其余病理诊断移植肾超急性排斥反应1例,急性抗体介导性排斥反应5例,慢性抗体介导性排斥反应2例,C4d免疫组织化学染色阳性16例。经过治疗8例抗体介导性排斥反应患者中4例移植肾功能得以恢复,3例未恢复,1例移植肾失功,移植肾切除。患者无不良反应发生。结果表明移植肾穿刺病理活检对移植肾无不良影响。

BACKGROUND：Acute humoral rejection, characterized as hormone resistance and refractory feature, often occurs in immune hypersensitivity recipients. OBJECTIVE：To observe the effect on antibody-mediated rejection during transplant kidney biopsy and to analyze the safety of transplant kidney biopsy. METHODS：Eighty-four patients underwent transplant kidney biopsy following renal transplantation. The biopsy was performed using B-ultrasound guided BARD puncture. Hematoxylin-eosin staining, histochemical staining and C4d immunohistochemical staining were performed. All biopsies were systematically diagnosed and evaluated according to the Banf 2005 schema. RESULTS AND CONCLUSION：Except for 1 case which was difficult to diagnose because of few tissues, there were 1 case of hyperacute rejection, 5 of acute antibody mediated rejection, 2 of chronic antibody mediated rejection, and 16 positive for C4d. After treatment, 4 of 8 antibody mediated rejection cases recovered renal transplantation, 3 did not recover, and 1 lost renal function. There were no adverse effects. The results showed that transplant kidney biopsy is safe and reliable for the assist diagnosis and treatment of renal dysfunction after renal transplantation.