移植肾活组织检查191例的病理学研究

A pathological study on 191 renal allograft biopsies

目的 研究供肾可能携带的病变及移植肾在术后出现合并症时相应的病理组织学变化。方法 对 191例移植肾进行了活组织检查 (以下简称“活检”) ,其中术中活检 5 2例 ,术后活检 139例 ,并进行病理学诊断与分类。结果 ( 1) 5 2例术中活检 ,40例 ( 76 .92 % )正常 ,余 12例 ( 2 3 .0 7% )供肾携带病变 ,其中细小动脉硬化 3例 ( 5 .77% )、间质炎症 4例 ( 7.6 9% )、局部肾小管轻度萎缩 3例( 5 .77% )、肾小管上皮细胞变性 2例 ( 3.84% )。 ( 2 ) 139例术后活检中明确诊断的 134例( 96 .40 % ) ,其中正常 19例 ( 13 .6 6 % )、超急性排斥反应 (SAR) 1例 ( 0 .71% )、疑为急性排斥反应 /临界性变化 (S/B) 15例 ( 10 .79% )、急性排斥反应 (AR) 2 3例 ( 16 .5 4% )、慢性移植肾肾病 (CAN) 37例( 2 6 .6 1% )、环孢素肾毒性损伤 (CsA NT) 2 9例 ( 2 0 .80 % )、急性肾小管坏死 (ATN) 8例 ( 5 .75 % )、复发性肾炎 (RN) 2例 ( 1.43 % )、难以明确诊断的 5例 ( 3 .5 9% )。 ( 3)免疫细胞化学染色显示AR时 ,侵入肾小管上皮内的Leu 7阳性细胞数增加 ,间质内CD6 8阳性细胞数明显增加。结论 活检是诊断术后多种合并症的有效手段 ;CAN可在术后 3个月发生 ;侵入肾小管上皮的Leu

Objective To investigate the pathological features in donor kidney (zero biopsy) and pathological changes in allograft kidney (post transplant biopsy).Method 191 renal allograft biopsies including 52 cases of perioperative biopsies and 139 cases of post operative biopsies were performed. All biopsies were systematically diagnosed and evaluated according to Banff 97 schema. SABC immunohistochemical staining was used to analyze the Leu 7 + and CD68 + expression during acute rejection. Results Among the 52 donor kidneys, 40 cases were normal ( 76.92 ?%), 12 cases had preexisting diseases ( 23.07 ?%), including hyaline arteriolar change in 3 cases, focal interstitial fibrosis in 4 cases, tubular atrophy in 3 cases and tubular epithelial degeneration in 2 cases. Among the 151 allografted kidneys, 19 were normal ( 13.66 ?%), one was diagnosed as having super acute rejection ( 0.71 ?%), 15 having suspicious of AR/bordline change ( 10.79 ?%), 23 having acute rejection ( 16.54 ?%), 37 having CAN ( 26.61 ?%), 29 having CsA NT ( 20.80 ?%), 8 having ATN( 5.75 ?%), 2 having recurrence nephropathy ( 1.43 ?%) and 5 cases were not classified ( 3.59 ?%). The SABC immunohistochemical staining showed that Leu 7 positive cells in the tubular epithelium and CD68 positive cells in the intestitial tissues were increased during acute rejection. Conclusion Biopsy is an valuable method to evaluate the pathological changes of donor kidney and diagnose the complications of allografted kidney. The changes of CAN could be found in 3 months posttransplantation. The presence of Leu 7 positive cells infiltrating the tubular epithelium is a reliable marker of acute rejection.