The clinical usefulness of the renal allograft biopsy in the cyclosporine era - A prospective study
The clinical usefulness of the renal allograft biopsy in the cyclosporine era - A prospective study
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DOI：
10.1097/00007890-199903150-00016
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发表时间：
1999-03-15
期刊：
影响因子：
6.2
通讯作者：
Williams, WW
中科院分区：
文献类型：
--
作者：
Pascual, M;Vallhonrat, H;Williams, WW
背景移植肾活检被普遍认为是明确肾功能不全原因的金标准，然而，这项手术的临床应用很少进行前瞻性研究，大多数研究也没有包括随访患者来描述活检对临床结局的影响。在这项研究中，我们前瞻性地评估了移植肾活检在接受环孢素（CyA）的肾移植受者中的临床应用。在21个月期间，进行了82次活检。在54例（47例患者）中，我们在手术前概述了假定诊断和暂定治疗计划。活检后，作出明确诊断，并制定了适当的患者管理方法。我们分析了由组织学检查结果引起的患者管理变化的发生率。对所有患者进行随访，以监测其对治疗的反应和同种异体移植物存活率。在活检证实的急性细胞排斥反应（ACR）或环孢霉素（CyA）毒性的病例中，回顾活检当天的临床和实验室数据，以确定其诊断价值。一份活检标本不足以进行明确的解释。活检结果导致其余53例病例中的22例（41.5%）患者管理发生变化（变化组）。在移植后第一个月、1 - 12个月和1年的活检标本中，改变患者管理的发生率分别为38.7%、55.6%和38.5%。2例慢性移植物功能障碍患者中有2例需要改变管理，45例急性移植物功能障碍患者中有44.4%需要改变管理，移植物功能延迟恢复的患者中无一例需要改变管理（n=6），在治疗的第一周内，改变组22例中的19例（86.4%）和无改变组31例中的25例（80.6%）对治疗有积极反应。两组的1年移植物存活率也相似。临床和实验室数据均不能用于区分ACR和CyA毒性。在根据临床和实验室检查结果作出推定诊断的患者中，约40%的患者的移植肾活检结果改变了患者的治疗建议。由于活检结果而改变患者管理的患者表现出对治疗的反应和同种异体移植物存活率与活检后管理计划未改变的患者相似。
Background. The renal allograft biopsy is generally accepted as the gold standard for clarifying the cause of renal dysfunction, However, the clinical usefulness of this procedure has rarely been studied prospectively, nor have most studies included follow-up of patients to delineate the influence of the biopsy on clinical outcome. In this study, we evaluated prospectively the clinical usefulness of the allograft biopsy in renal transplant recipients receiving cyclosporine (CyA).Methods. During a 21-month period, 82 biopsies were performed. In 54 instances (47 patients), we outlined a presumed diagnosis and tentative treatment plan before the procedure. After the biopsy, a definitive diagnosis was made and an appropriate patient management approach was instituted. We analyzed the incidence of change in patient management that resulted from histological findings. All patients were followed to monitor their response to treatment and allograft survival. In cases of biopsy-proven acute cellular rejection (ACR) or cyclosporine (CyA) toxicity, clinical and laboratory data from the day of the biopsy were reviewed to determine their diagnostic value.Results. One biopsy specimen was inadequate for definitive interpretation. The biopsy findings resulted in a change in patient management in 22 (41.5%) of the remaining 53 cases (change group). The incidence of altered patient management was 38.7% in biopsy specimens taken in the first month, 55.6% between 1 and 12 months, and 38.5% after 1 year posttransplantation. A change in management was required in 2 of 2 patients with chronic allograft dysfunction, in 44.4% of the 45 patients with acute allograft dysfunction, and in none of the patients with delayed graft function (n=6), Within the first week of treatment 19 of 22 (86.4%) in the change group and 25 of 31 (80.6%) in the no change group had a positive response to therapy. The 1-year allograft survival rate was also similar between the two groups. None of the clinical and laboratory data was useful in distinguishing ACR from CyA toxicity.Conclusions. Renal allograft biopsy findings alter patient management recommendations in approximately 40% of patients in whom a presumptive diagnosis had been made on the basis of clinical and laboratory findings. Patients who had a change in patient management because of biopsy findings demonstrated a response to therapy and allograft survival similar to those of patients who had no alteration in management plan after the biopsy.