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目的总结亲属活体肾移植后移植肾组织活检资料,并结合临床进行回顾性分析。方法亲属活体肾移植55例,其中有血缘的亲属供肾移植53例,夫妻间供肾移植2例。供、受者间HLA配型,1条单倍型相同者45例,2条单倍型相同者6例,5个抗原错配者3例,完全错配者1例。除1例采用腹腔镜取肾外,其余均采取开放手术取肾。供肾热缺血时间1~8min,冷缺血时间1~2h。术后应用环孢素A(或他克莫司)、硫唑嘌呤(或霉酚酸酯)及泼尼松预防排斥反应。结果55例中,有10例接受16次移植肾活检,结果4例次为急性排斥反应(Banff分级均为Ⅰ级),3例次经甲泼尼龙冲击治疗逆转,1例合并慢性移植肾肾病,治疗无效,恢复透析;3例次为移植肾退行性病变(其中2例合并急性环孢素A肾毒性损伤),2例减少环孢素A用量,并加用西罗莫司,效果良好,1例将环孢素A转换为西罗莫司,效果不佳,恢复透析;4例次为急性肾小管坏死,采用他克莫司和霉酚酸酯联合用药,并辅以透析治疗,肾功能恢复正常。结论虽然亲属活体肾移植术后急性排斥反应和移植肾功能恢复延迟的发生率低,但仍应重视术后移植肾组织活检,将被动活检转为主动的计划性活检,以提高亚临床排斥反应的检出率。
Objective To summarize the biopsy data of renal allograft kidney transplantation and to conduct retrospective analysis with clinical data. Methods 55 cases of living relatives kidney transplantation, including blood relatives for kidney transplantation in 53 cases, between husband and wife donor kidney transplantation in 2 cases. There were 45 HLA haplotypes, 6 haplotypes of the same 2 haplotypes, 3 mismatch of 5 antigens and 1 complete mismatch. In addition to 1 case of laparoscopic kidney, the rest are taken to open surgery kidney. Renal ischemia for 1 to 8 minutes, cold ischemia for 1 to 2 hours. Postoperative application of cyclosporine A (or tacrolimus), azathioprine (or mycophenolate mofetil) and prednisone to prevent rejection. Results Of the 55 cases, 10 received 16 graft biopsies. The results were 4 cases of acute rejection (grade Ⅰ in the Banff classification), 3 cases of reversal by methylprednisolone and 1 case of chronic allograft nephropathy , Treatment was ineffective, and dialysis was resumed. Three cases of renal allograft degeneration (2 cases with acute cyclosporine A nephrotoxicity), 2 cases of cyclosporin A reduced dosage, and the addition of sirolimus was effective , 1 case of cyclosporine A converted to sirolimus, the effect is not good, to restore dialysis; 4 cases of acute tubular necrosis, the use of tacrolimus and mycophenolate mofetil combined with dialysis treatment, Renal function returned to normal. Conclusions Although the incidence of acute rejection and delayed graft recovery after living-related kidney transplantation is low, postoperative biopsy of renal tissue should be emphasized, and passive biopsy should be turned into an active planned biopsy in order to improve subclinical rejection The detection rate.