Kidney transplant biopsies in the diagnosis and management of acute rejection reactions
| Autor: | Christine Bastl, Michael Kashgarian, Norman J. Siegel, Fredric O. Finkelstein, John N. Forrest |
|---|---|
| Rok vydání: | 1976 |
| Předmět: |
Gynecology
Immunosuppressive treatment Graft Rejection Transplant biopsy medicine.medical_specialty Time Factors medicine.diagnostic_test business.industry Biopsy Needle Kidney Kidney transplant Kidney Transplantation Surgery Interstitial edema Renal transplant Nephrology Biopsy Acute Disease Retrospective analysis Medicine Humans Transplantation Homologous business |
| Zdroj: | Kidney International. 10(2):171-178 |
| ISSN: | 0085-2538 |
| DOI: | 10.1038/ki.1976.92 |
| Popis: | Kidney transplant biopsies in the diagnosis and management of acute rejection reactions. In 68 consecutive renal transplant biopsies, histopathologic changes and clinical status of the graft recipient, both at the time of biopsy as well as one month later, were evaluated by independent observers. Nine histologic features were graded semiquantitatively (scale, 0 to 4): glomerular endothelial swelling, proliferation, exudation and necrosis; interstitial edema and infiltrate; vascular endothelial edema, infiltration and necrosis. The total score for each biopsy was termed the acute rejection index (ARI). The validity of the ARI as a means of evaluating rejection reactions was established by correlating the ARI with a second, overall histopathologic categorization. Clinical status at the time of biopsy was classified by retrospective analysis of all clinical data except the biopsy. The mean ARI of patients with an acute clinical rejection was significantly higher than those of patients with just a chronic clinical rejection or no clinical rejection. The utility of the biopsy in predicting the response of the graft recipient to therapy was evaluated in those 46 patients in whom an acute rejection was diagnosed clinically and in whom a full and complete course of therapy for the acute clinical rejection was given. Of the 28 patients whom the pathologist predicted would respond to therapy, 27 did show substantial improvement of their renal function up to one month following institution of treatment. Of the 18 patients whom the pathologist predicted would not respond to therapy, 15 had no clinical response. The data suggest that the transplant biopsy is helpful in 1) establishing the diagnosis of an acute rejection and 2) indicating whether or not the graft recipient will respond to standard immunosuppressive treatment for an acute rejection. Biopsies de reins transplantes dans le diagnostic et le traitement de reactions de rejet aigu. Dans 68 transplantations renales consecutives les modifications histologiques du transplant et l'etat clinique du receveur ont ete evalues par des observateurs independants a la fois au moment de la biopsie puis un mois plus tard. Neuf aspects histologiques ont ete apprecies de maniere semiquantitative (echelle de 0 a 4): le gonflement de l'endothelium glomerulaire, la proliferation, l'exsudation et la necrose; l'oedeme interstitiel et l'infiltration; l'oedeme endothelial, l'infiltration et la necrose des vaisseaux. Le total dans chaque biopsie a ete appele index de rejet aigu (ARI). La validite de ARI dans l'evaluation des reactions de rejet a ete etablie en correlant ARI avec une deuxieme classification histologique globale. L'etat clinique au moment de la biopsie a ete classe par l'analyse retrospective de tous les documents cliniques a l'exception de la biopsie. Le ARI moyen des malades atteints de rejet aigu est significativement superieur a celui des malades atteints seulement de rejet clinique chronique ou indemnes de rejet clinique. L'utilite de la biopsie dans le pronostic de la reponse du receveur au traitement a ete evaluee pour les 46 malades chez lesquels un traitement de rejet aigu a ete pleinement realise en doses et en duree. Parmi les 28 malades pour lesquels l'anatomo-pathologiste avait prevu qu'ils repondraient au traitement 27 ont eu une amelioration substantielle de la fonction renale dans le mois qui a suivi l'institution du traitement. Parmi les 18 malades pour lesquels l'anatomo-pathologiste avait prevu qu'ils ne repondraient pas au traitement 15 n'ont eu aucun effet clinique. Les observations suggerent que la biopsie du transplant est utile pour 1) etablir le diagnostic de rejet aigu et 2) indiquer si le receveur repondra au traitement immunosuppresseur habituel du rejet aigu. |
| Databáze: | OpenAIRE |
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