伴急性肾损伤供体移植前行供肾穿刺活检病理检查的临床意义
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摘要
目的:探讨在器官捐献供体存在急性肾损伤(AKI)情况下,移植前行供肾穿刺病理学检查的临床意义。方法:选取2015年6月至2018年4月伴随AKI的器官捐献供体,其中23例移植前对供体行肾穿刺活检,根据活检结果及Banff评分决定是否采用该肾脏用作移植。结果:行肾活检的23例供体中,病理表现有急性肾小管损伤、肾小球硬化、肾间质纤维化、肾小管萎缩、小动脉内玻璃样变及动脉内膜纤维化;其中5例Banff评分大于3分者弃用该器官。结论:供肾病理表现中血管病变和急性肾小管损伤较为常见,病理病变程度重、Banff评分大于3分者建议弃用该器官。
Objective: To explore the clinical significance of renal biopsy before transplantation in the case of acute kidney injury( AKI)in organ donor. Methods: Death organ donors with AKI from June 2015 to April 2018 were retrospectively reviewed. 23 Cases of donors were underment preimplantation kindney biopsy. Whether to use the kidney for transplantation was based on biopsy results and Banff score.Results: Among the 23 donors who underwent renal biopsy,the pathological manifestations included acute renal tubular injury,glomerular sclerosis,renal interstitial fibrosis,renal tubule atrophy,small arterial vitreous degeneration and intimal arterial fibrosis. The organ was deprecated in 5 cases with Banff score greater than 3. Conclusion: Vascular lesions and acute renal tubular injury are common in the pathologic manifestations of donor kidney. The organ with severe pathological lesions and Banff score greater than 3 is advised to be deprecated.
Objective: To explore the clinical significance of renal biopsy before transplantation in the case of acute kidney injury( AKI)in organ donor. Methods: Death organ donors with AKI from June 2015 to April 2018 were retrospectively reviewed. 23 Cases of donors were underment preimplantation kindney biopsy. Whether to use the kidney for transplantation was based on biopsy results and Banff score.Results: Among the 23 donors who underwent renal biopsy,the pathological manifestations included acute renal tubular injury,glomerular sclerosis,renal interstitial fibrosis,renal tubule atrophy,small arterial vitreous degeneration and intimal arterial fibrosis. The organ was deprecated in 5 cases with Banff score greater than 3. Conclusion: Vascular lesions and acute renal tubular injury are common in the pathologic manifestations of donor kidney. The organ with severe pathological lesions and Banff score greater than 3 is advised to be deprecated.
引文
[1]Azancot MA,Moreso F,Salcedo M,et al.The reproducibility and predictive value on outcome of renal biopsies from expanded criteria donors[J].Kidney Int,2014,85(5):1161-1168.
[2]Lamarche C,C8téJM,Sénécal L,et al.Efficacy of acute cellular rejection treatment according to banff score in kidney transplant recipients:asystematic review[J].Transplant Direct,2016,2(12):e115.
[3]Dhanani S,Shemie SD.Advancing the science of organ donor management[J].Crit Care,2014,18(6):612.
[4]薛武军.公民逝世后器官捐献供肾评估方法及改善的研究进展[J].器官移植,2015,6(3):131-133.
[5]陈越,崔春黎,张昆,等.经肾活检证实的老年肾脏病的临床病理特点及预后[J].中国老年学杂志,2018,38(1):176-178.
[6]李金锋,孙佳佳,丰贵文,等.供肾零点活检对中老年公民逝世器官捐献供肾的评价[J].中华老年医学杂志,2018,37(3):306-310.
[7]刘磊,庞新路,尚文俊,等.供肾移植前常规病理学评估对移植后早期肾功能的影响[J].中华器官移植杂志,2017,38(10):607-613.
[8]Lee AL,Huh KH,Lee SH,et al.Significance of Time-Zero Biopsy for Graft Renal Function After Deceased Donor Kidney Transplantation[J].Transplant Proc,2016,48(8):2656-2662.
[9]HAAS M.Donor kidney biopsies:pathology matters,and so does the pathologist[J].Kidney Int,2014,85(5):1016-1019.
[10]彭风华,陈靖靓,彭龙开,等.选择性供肾病理检查评估的临床意义[J].中华医学杂志,2018,98(3):186-190.
[11]Farney AC,Rogers J,Orlando G,et al.Evolving experience using kidneys from deceased donors with terminal acute kidney injury[J].J Am Coll Surg,2013,216(4):645-655.
[12]王红宇,焦宪法,牛杏果,等.伴急性肾损伤的脑死亡器官捐献供者供肾移植治疗的体会[J].器官移植,2017,8(6):424-429.
[13]Tavares da Silva E,Oliveira R,Castelo D,et al.Pretransplant biopsy in expanded criteria donors:do we really need it?[J].Transplant Proc,2014,46(10):3330-3334.
[14]Haas M,Segev DL,Racusen LC,et al.Arteriosclerosis in kidneys from healthy live donors:comparison of wedge and needle core perioperative biopsies[J].Arch Pathol Lab Med,2008,132(1):37-42.
[15]Naesens M.Zero-time renal transplant biopsies:acomprehensive review[J].Transplantation,2016,100(7):1425-1439.
[16]邹万忠.肾活检病理诊断的特点[J].中华病理学杂志,2012,41(2):73-75.
[17]Orlando G,Danger R,Okut H,et al.Molecular pathways underlying adaptive repair of the injured kidney:novel donation after cardiac death and acute kidney injury platforms[J].Ann Surg,2018 Jul 24.doi:10.1097/SLA.0000000000002946.
[18]Tomita Y,Iwadoh K,Ogawa Y,et al.Single graft utilization from donors with severe acute kidney injury after circulatory death[J].Transplant Direct,2018,4(4):e355.
[19]Heilman RL,Smith ML,Smith BH,et al.Progression of Interstitial Fibrosis during the First Year after Deceased Donor Kidney Transplantation among Patients with and without Delayed Graft Function[J].Clin J Am Soc Nephrol,2016,11(12):2225-2232.
[20]Baker RJ,Mark PB,Patel RK,et al.Renal association clinical practice guideline in post-operative care in the kidney transplant recipient[J].BMCNephrol,2017,18(1):174.
[2]Lamarche C,C8téJM,Sénécal L,et al.Efficacy of acute cellular rejection treatment according to banff score in kidney transplant recipients:asystematic review[J].Transplant Direct,2016,2(12):e115.
[3]Dhanani S,Shemie SD.Advancing the science of organ donor management[J].Crit Care,2014,18(6):612.
[4]薛武军.公民逝世后器官捐献供肾评估方法及改善的研究进展[J].器官移植,2015,6(3):131-133.
[5]陈越,崔春黎,张昆,等.经肾活检证实的老年肾脏病的临床病理特点及预后[J].中国老年学杂志,2018,38(1):176-178.
[6]李金锋,孙佳佳,丰贵文,等.供肾零点活检对中老年公民逝世器官捐献供肾的评价[J].中华老年医学杂志,2018,37(3):306-310.
[7]刘磊,庞新路,尚文俊,等.供肾移植前常规病理学评估对移植后早期肾功能的影响[J].中华器官移植杂志,2017,38(10):607-613.
[8]Lee AL,Huh KH,Lee SH,et al.Significance of Time-Zero Biopsy for Graft Renal Function After Deceased Donor Kidney Transplantation[J].Transplant Proc,2016,48(8):2656-2662.
[9]HAAS M.Donor kidney biopsies:pathology matters,and so does the pathologist[J].Kidney Int,2014,85(5):1016-1019.
[10]彭风华,陈靖靓,彭龙开,等.选择性供肾病理检查评估的临床意义[J].中华医学杂志,2018,98(3):186-190.
[11]Farney AC,Rogers J,Orlando G,et al.Evolving experience using kidneys from deceased donors with terminal acute kidney injury[J].J Am Coll Surg,2013,216(4):645-655.
[12]王红宇,焦宪法,牛杏果,等.伴急性肾损伤的脑死亡器官捐献供者供肾移植治疗的体会[J].器官移植,2017,8(6):424-429.
[13]Tavares da Silva E,Oliveira R,Castelo D,et al.Pretransplant biopsy in expanded criteria donors:do we really need it?[J].Transplant Proc,2014,46(10):3330-3334.
[14]Haas M,Segev DL,Racusen LC,et al.Arteriosclerosis in kidneys from healthy live donors:comparison of wedge and needle core perioperative biopsies[J].Arch Pathol Lab Med,2008,132(1):37-42.
[15]Naesens M.Zero-time renal transplant biopsies:acomprehensive review[J].Transplantation,2016,100(7):1425-1439.
[16]邹万忠.肾活检病理诊断的特点[J].中华病理学杂志,2012,41(2):73-75.
[17]Orlando G,Danger R,Okut H,et al.Molecular pathways underlying adaptive repair of the injured kidney:novel donation after cardiac death and acute kidney injury platforms[J].Ann Surg,2018 Jul 24.doi:10.1097/SLA.0000000000002946.
[18]Tomita Y,Iwadoh K,Ogawa Y,et al.Single graft utilization from donors with severe acute kidney injury after circulatory death[J].Transplant Direct,2018,4(4):e355.
[19]Heilman RL,Smith ML,Smith BH,et al.Progression of Interstitial Fibrosis during the First Year after Deceased Donor Kidney Transplantation among Patients with and without Delayed Graft Function[J].Clin J Am Soc Nephrol,2016,11(12):2225-2232.
[20]Baker RJ,Mark PB,Patel RK,et al.Renal association clinical practice guideline in post-operative care in the kidney transplant recipient[J].BMCNephrol,2017,18(1):174.
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