482例肾移植供肾病理分析

Pathologic analysis of donor grafts in 482 cases of renal transplantation recipients

目的 探讨供肾组织病理表现与移植肾发生急慢性排斥等移植后病变的相关性。 方法 观察 482例移植肾供肾活检组织的光镜表现 ,结合移植后情况进行分析。 结果 移植后发生急性排斥反应 71例 ,其中 16例 (2 2 .5 % )供肾组织有不良改变 ;慢性移植物肾病 17例 ,其中 7例 (41.2 % )供肾组织有不良改变 ;不明原因血肌酐升高 3 9例 ,其中 7例 (18.0 % )供肾组织有不良改变。移植肾供肾的不良改变与急性排斥的发生以及临床血肌酐升高无关 (r≤ 0 .3 ) ,某些不良改变与慢性移植物肾病的发生有一定相关性 (r>0 .3 )。 结论 移植肾供肾组织常规活检有助于及早发现不良因素 ;供肾组织的一些病理现象与术后移植肾急性排斥反应及某些临床异常表现无相关性 。

Objective To evaluate the correlation between the pathologic findings of donor renal grafts and the post transplantative diseases through the biopsies of donor grafts in 482 cases. Methods The renal structures of biopsies of the donor grafts in 482 cases were observed under microscope,and the pathologic findings combined with the post transplantative conditions were analysed. Results After transplantation,acute rejection occurred in 71 cases,of whom 16(22.5%) had adverse changes in donor grafts;chronic allograft nephropathy developed in 17 cases,of whom 7(41.2%) had adverse changes in donor grafts;elevated sera creatinine levels with unknown causes occurred in 39 cases,of whom 7(18.0%) had adverse changes in donor grafts.The lesion of donor renal grafts had nothing to do with the acute rejection or other abnormalities after operation ( r ≤0.3) but some kind of lesion had certain correlation with chronic allograft nephropathy(CAN, r >0.3). Conclusions Routine biopsy of donor renal graft is helpful in finding abnormalities as soon as possible.The lesions of donor renal graft may have certain correlation with CAN,but have no association with acute rejection or other abnormalities after renal transplantation.