Abstract
Objective To study the clinicopathologic features of renal transplant recipients whose transplant kidneys were from adult donors after C - Ⅲ donation of cardiac death(DCD),to provide a reference for clinical practice. Methods 32 renal transplant recipients who were treated in 458th Hospital of PLA and 303th Hospital of PLA from September 2011 to May 2014,were selected as study subjects,their transplant kidneys were from donors after C - Ⅲ DCD,36 cases underwent needle biopsy of transplant kidney or received pathological examination after transplant nephrectomy,the pathological results were determined by two pathologic doctors with secondary senior positions according to the 2007 Banff system of working classification of renal allograft pathology. 40 renal transplant recipients who were treated in 458th Hospital of PLA and 303th Hospital of PLA during the same period,were selected as control subjects,their kidneys were from cadaver donors,40 cases underwent needle biopsy of transplant kidney. Incidences of acute tubular necrosis( ATN),tacrolimus( Tac)toxicity damage,acute rejection (AR),chronic rejection(CR),new/ relapse nephropathy,tubular atrophy and interstitial fibrosis were compared between two groups. Results 32 DCD renal transplant recipients were treated with triple drug therapy( Tac + mycophenolate mofetil +prednisone). Pathological findings,Visual inspection:The biopsy specimens were gray fine strip organization,the length was between 0. 8 cm and 1. 5 cm,the diameter was about 0. 1 cm,the transplant kidneys showed normal shape and size,the structure of medulla and cortex was clear,renal pelvic mucosa was smooth and no expansion was observed,no thrombosis was found in renal hilum blood vessels,narrow and expansion of the ureter were not found. Microscopic examination:1 case had fewer number of glomerulus,and the other 35 cases were qualified. 19 cases had minor glomerular abnormalities,14 cases had glomerulosclerosis,13 cases had extravasated blood. Tubular necrosis of 35 cases had lesions,12 cases had minimal or multifocal necrosis of tubular necrosis,12 cases had tubular atrophy,14 cases had lymphocytes infiltration of renal interstitium,18 cases had swelling or thickening of endarterium. The final pathological diagnosis of DCD renal transplant recipients(35 cases):18 cases(60. 0% )had Tac toxicity damage,12 cases(34. 3% )had ATN,7 cases(20. 0% )had new/ relapse nephropathy,6 cases(17. 1% )had AR,and 2 cases(5. 7% )had CR. Incidences of Tac toxicity damage,ATN and AR in study subjects were significantly higher than that of control subjects,respectively(P < 0. 05). There was no significant difference in incidences of CR, new/ relapse nephropathy, tubular atrophy and interstitial fibrosis between study subjects and control subjects (P > 0. 05). Conclusion The main pathological changes of post - transplant kidney from C - Ⅲ DCD donors were Tac toxicity damage,ATN and ornew/ relapse nephropathy. The early curative effect for transplant recipients is poor,these diseases should be prevented and treated,thus the curative effect of kidney transplantation from donators after C - Ⅲ DCD can be improved.关键词
肾移植/心脏死亡/器官捐献/病理状态,体征和症状Key words
Kidney transplantation/Cardiac death/Organ donation/Pathological conditions,signs and symptoms分类
医药卫生
