相同移植肾重复活检37例临床病理分析

Repeated biopsies for the same kidney allograft:a clinicopathologic analysis of 37 cases

目的总结中国人民解放军第三0三医院移植中心移植肾重复活检病例的主要病理诊断、病变和预后,为肾移植术后并发症的临床诊疗提供参考。方法对该院2011年5月—2017年5月同一移植肾3年内进行了重复指征性活检的37例移植肾患者资料进行回顾性研究,归纳病变数量较多的以及再次活检仍然存在病理改变患者进行临床病理学分析。结果 32例患者进行了2次、5例患者进行了3次穿刺活检共79例次活检中,诊断结果显示疾病出现频次最多的依次为神经钙蛋白抑制剂(CNI)中毒37例次(46.84%)、肾小管间质性肾炎(TIN)24例次(30.38%)和急性排斥反应18例次(22.78%);37例患者中有24例前后2次或3次病理诊断完全或部分相同,其中重复频次最多的依次为CNI中毒12例次、边缘供肾8例次、TIN 7例次。结论 CNI中毒、TIN对移植肾的损害应受到重视,来自公民逝世后捐献的边缘供肾应用值得进一步尝试和探索。

Objective To summarize the main pathologic diagnoses,disease changes and prognosis of the kidney allograft of the recipients who received repeated biopsies in the Organ Transplantation Centre of the 303th Hospital of the Chinese People’s Liberation Army so as to provide references for clinical diagnosis and treatment of complications after kidney transplantation. Methods A retrospective study was performed for 37 kidney transplant patients who received repeated biopsies within 3 years because the same kidney allograft carried indications for repeated biopsies from May 2011 to May 2017.Patients who had higher incidences of diagnosed diseases and who still carried pathologic changes by repeated biopsy were selected for clinicopathologic analysis. Results In all 79 times of biopsies,32 recipients accepted biopsies twice and 5 recipients accepted it three times.Biopsy diagnosed results showed that the frequency of disease occurrence from high to low ranked as:calcineurin inhibitor(CNI)toxicity(37 case-times,46.84%),followed by renal tubular interstitial nephritis(TIN)(24 case-times,30.38%)and acute rejection(18 case-times,22.78%).Twenty-four cases of 32 patients got the all or part of the same diagnosis at the second or the third times of biopsies.The diagnosed diseases repeated with the highest frequency was toxicity damage by CNI(12 case-times),followed by marginal grafts(8 case-times)and tubular interstitial nephritis(7 case-times). Conclusion More attention should be paid to the allograft damage induced by CNI toxicity and TIN.It’s worth making further trial and study of using marginal graft from donation after citizen death.