Histopathological characteristics and causes of kidney graft failure in the current era of immunosuppression.
Histopathological characteristics and causes of kidney graft failure in the current era of immunosuppression.
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DOI：
10.5500/wjt.v9.i6.123
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发表时间：
2019-10-28
期刊：
影响因子：
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通讯作者：
Djamali, Arjang
中科院分区：
文献类型：
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作者：
Parajuli, Sandesh;Aziz, Fahad;Djamali, Arjang
背景：现代同种异体肾移植失败的组织病理学表现尚未得到很好的研究。目的：根据移植后的时间、终末期肾病的病因和诱导免疫抑制药物，报告在当前免疫抑制时代移植失败的肾移植的组织病理学特征。方法：在一项单中心观察性研究中，我们描述了肾移植受者活检后一年内移植失败的组织病理学结果。结果：在2006年1月1日至2016年12月31日期间，我们确定了329例符合选择标准的移植失败患者。最常见的三种活检结果是间质纤维化和肾小管萎缩(IFTA，53%)，急性排斥(AR，43%)和移植肾小球病变(TG，33%)。同样，根据初步诊断，移植物失败的三个最常见原因是AR(40%)、TG(17%)和IFTA(13%)。大多数移植物在移植后两年内失败(36%)。随后，每两年大约有10%-15%的移植物失败：>；2-4年(16%)，>；4-6年(13%)，>；6-8年(11%)，>；8-10年(9%)和>；10年(16%)。在移植后6年，AR是最常见的原因(48%)，而TG是最常见的原因(32%)。结论：在当前免疫抑制的时代，AR仍然是导致早期移植失败的最常见原因，而TG是最常见的晚期移植失败原因。
BACKGROUND: The histopathological findings on the failing kidney allograft in the modern era is not well studied. In this study, we present our experience working with kidney transplant recipients with graft failure within one year of the biopsy.AIM: To report the histopathological characteristics of failed kidney allografts in the current era of immunosuppression based on the time after transplant, cause of the end-stage renal disease and induction immunosuppressive medications.METHODS: In a single-center observational study, we characterized the histopathological findings of allograft biopsies in kidney transplant recipients with graft failure within one year after the biopsy.RESULTS: We identified 329 patients with graft failure that met the selection criteria between January 1, 2006 and December 31, 2016. The three most common biopsy findings were interstitial fibrosis and tubular atrophy (IFTA, 53%), acute rejection (AR, 43%) and transplant glomerulopathy (TG, 33%). Similarly, the three most common causes of graft failure based on the primary diagnosis were AR (40%), TG (17%), and IFTA (13%). Most grafts failed within two years of post-transplant (36%). Subsequently, approximately 10%-15% of grafts failed every two years: > 2-4 years (16%), > 4-6 years (13%), > 6-8 years (11%), > 8-10 years (9%) and > 10 years (16%). AR was the most common cause of graft failure in the first six years (48%), whereas TG was the most prevalent cause of graft failure after 6 years (32%) of transplant.CONCLUSION: In the current era of immunosuppression, AR is still the most common cause of early graft failure, while TG is the most prevalent cause of late graft failure.