Transplant böbrek sıfır saat iğne biyopsilerinde saptanan histopatolojik bulgular ve önemi

Retroperitoneal leiomyosarkom, sigmoid kolon adenokarsinomu ve renal hücreli karsinomdan oluşan senkron primer triple tümörü olan 67 yaşında bir erkek olgu sunulmaktadır. Olguda sigmoid kolon rezeksiyonu gerçekleştirildikten bir ay sonra retroperitoneal kitle eksizyonu ve sol nefrektomi uygulandı. Olgu onüç aydır klinik takiptedir ve nüks veya metastazla uyumlu bulgu tespit edilememiştir. Yazımızda, cerrahi uygulamada ender görülen bir olgu olması nedeni ile triple veya daha çok sayıdaki primer malign tümörler gözden geçirildi.

Anahtar Kelimeler:

Böbrek nakli, Patoloji, Biyopsi, Görülme sıklığı, Doku vericileri, Histoloji, Mikroskopi

The importance of histopathological findings in zero hour needle biopsies of renal transplants

In our transplant center living kidney donors are generally elderly relatives of the patients. Thus, some of the morphologic findings in zero hour needle biopsies (ZHNB's) might be related to aging. In the present study, we investigated the incidence of histopathological changes in ZHNB's from 60 cases and compared the results of age groups under and over forty. The ZHNB's were examined by light and immunofluorescence microscopy. All histopathological findings were recorded. Donors were classified according to age, over and under 40. The results of findings were compared statistically using tests for independent samples. At least one histopathologic finding was found in 87% of biopsies. The findings were prominent in 25%. Glomerulosclerosis, interstitial fibrosis, interstitial inflammatory infiltration, tubular atrophy, intimal hyalin deposits, intimal fibrosis and lamina elastica changes were observed in 33%, 42%, 40%, 30%, 43%, 50%, and 20%, respectively. Interstitial fibrosis, interstitial inflammatory infiltration, tubular atrophy, intimal hyaline nodules, intimal fibrosis and lamina elastica changes were significantly higher in biopsies of the donors over 40 (pi<0.005). Out of 25 cases examined by immunofluoresance microscopy, 60% of biopsies showed nonspecific, weak deposits in arterioles and/or glomeruli. Our results revealed that the incidence of ZHNB's findings were higher in older patients. Some of these findings are important for the differential diagnosis of chronic allograft nephropaty and cyclosporine nephrotoxicity, therefore we emphasized the importance of histopathological changes in ZHNB's from aged donors.

Keywords:

Kidney Transplantation, Pathology, Biopsy, Incidence, Tissue Donors, Histology, Microscopy,

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1.Curschellas E, Landmann L, Durig M, et al. Morphologic findings in "zero-hour" biopsies of renal transplants. Clin Nephrol 1991;36:215-222.
2. Gaber LW, Gaber AO, Tolley EA, Hathavvay DK. Prediction by postrevascularization biopsies of cadaveric kidney allografts of rejection, graft loss and preservation nephropathy. Transplantation 1992;53:1219-1225.
3. Gaber LW, Moore LW, Allovvay RR, Amiri MH, Vera SR, Gaber AO. Glomerulosclerosis as a determinant of posttransplant function of older donor renal allografts. Transplantation 1995;60:334-339.
4. Taub HC, Greenstein SM, Lerner SE, Schechner R, Tellis VA:. Reassesment of the value of post-vascularization biopsy performed at renal transplantation: The efffects of arteriosclerosis. J Urology 1994; 151:575-577.
5. Spector D, Limas C, Frost JL, et al. Perfusion nephropathy in human transplants. New Engl J Med 1976;25:1217-1221.
6. Seron D, Carrera M, Grino JM, at al. Relationship between donor renal interstitial surface and post-transplant function. Nephrol Dial Transplant 1993;8:539-543.
7. Pardo-Mindan FJ, Salinas-Madrigal L, Idoate M, Garola R, Sola I, French M. Pathology of renal transplantation. Semin Diag Pathol 1992;9 (3):185-199.
8. Racusen LC, Solez K, Olsen S. Pathology of Kidney Transplantation. İn: Solez K, Raousen LC, Billingham ME (eds) Solid organ transplant reiection. Mechanisms, Pathology and Diagnosis. Marcel Dekker Inc. New York, 1996, pp 207-241.
9. Solez K, Axelsen RA, Benediktsson H, et al. International standardization of criteria for the histologic diagnosis of renal allograft rejection: The Bannf vvorking classification of kidney transplant pathology. Kidney Int 1993;44:411-422.
10. Solez K, Racusen L, Rayner D, Olsen S, Halloran P. The Banff schema four years later. Transplant Proc 1996;28:450-452.
11. Colvin RB, CohenJJ, Harrington JT, Madias NE, Zusman CJ. The renal allograft biopsy. Kidney Int 1996;50:1069-1082.
12. Cosyns JP, Malaise J, Hanique G, et al. Lesions in donor kidneys: nature, incidence, and influence on graft function. Transplant Int 1998;11 (1):22-27.
13. Szanya J, Szakaly P, Magyarlaki T, Balogh Z, Nagy J, Nagy KK. Predictive morphological findings in "zero-hour" biopsies of renal allografts. Açta Chir Hung 1997;36(1-4):346-348.
14. Nyberg G, Hedman L, Blohme I, Svalander C. Morphologic findings in baseline kidney biopsies from living related donors. Transplant Proc 1992;24(1):355-356.
15. Rosenberg HG, Martinez PS, Vaccarezza AS, Martinez LV. Morphological findings in 70 kidneys of living donors for renal transplant. Pathol Res Pract 1990;186(5):619-624.
16. Wang HJ, Kjellstrand CM, Cockfield SM, Solez K. On the influence of sample size on the prognostic accuracy and reproducibility of renal transplant biopsy. Nephrol Dial Transplant 1998;13:165-172.
17. Andersen CB, Ladefoged SD, Larsen S. Acute kidney graft rejection. A morphological and immunohistological study on "zero hour" and follow-up biopsies with special emphasis on cellular infiltrates and adhesion molecules. APMIS 1994; 102:23-37.
18. Perloff LJ, Goodloe S, Jenis EH, Light JA, Spees EK. Value of one hour renal allograft biopsy. Lancet 1973;2:1294-1295.
19. Dunnill MS. Histopathology of renal allograft rejection. İn Morris PJ (ed), Kidney Transplantation principles and practise (4 nd ed). WB Saunders, Philadelphia 1994, pp 266-285.
20. Croker BP, Ramos EL. Pathology of renal allograft. İn: Tisher CC, Brenner BM (eds) Renal Pathology, with clinical and functional correlations (2 nd ed). JB Lippincott Company Philadelphia 1993, pp 1591-1640.
21. Mihatsch MJ, Gudat F, Ryffel B, Thiel G. Cyclosporine nephropathy. İn: Tisher CC, Brenner BM (eds) Renal Pathology, with clinical and functional correlations (2 nd ed). Philadelphia, JB Lippincott Company 1993, pp 1641-1681.
22. Isonemi H, Von VVİllebrand E, Krogerus L, Taskinen E, Ahonen J, Hayry P. The effect of donor age on kidney graft function and histopathological findings. Transplant Proc 1992;24:328-329.
23. Rao VK, Kasiske BL, Odlund MD, Ney AL, Andersen RC. İnfluence of kadaver donor age on posttransplant renal function and graft outcome. Transplantation 1990;49:91-95.
1.Curschellas E, Landmann L, Durig M, et al. Morphologic findings in "zero-hour" biopsies of renal transplants. Clin Nephrol 1991;36:215-222.
2. Gaber LW, Gaber AO, Tolley EA, Hathavvay DK. Prediction by postrevascularization biopsies of cadaveric kidney allografts of rejection, graft loss and preservation nephropathy. Transplantation 1992;53:1219-1225.
3. Gaber LW, Moore LW, Allovvay RR, Amiri MH, Vera SR, Gaber AO. Glomerulosclerosis as a determinant of posttransplant function of older donor renal allografts. Transplantation 1995;60:334-339.
4. Taub HC, Greenstein SM, Lerner SE, Schechner R, Tellis VA:. Reassesment of the value of post-vascularization biopsy performed at renal transplantation: The efffects of arteriosclerosis. J Urology 1994; 151:575-577.
5. Spector D, Limas C, Frost JL, et al. Perfusion nephropathy in human transplants. New Engl J Med 1976;25:1217-1221.
6. Seron D, Carrera M, Grino JM, at al. Relationship between donor renal interstitial surface and post-transplant function. Nephrol Dial Transplant 1993;8:539-543.
7. Pardo-Mindan FJ, Salinas-Madrigal L, Idoate M, Garola R, Sola I, French M. Pathology of renal transplantation. Semin Diag Pathol 1992;9 (3):185-199.
8. Racusen LC, Solez K, Olsen S. Pathology of Kidney Transplantation. İn: Solez K, Raousen LC, Billingham ME (eds) Solid organ transplant reiection. Mechanisms, Pathology and Diagnosis. Marcel Dekker Inc. New York, 1996, pp 207-241.
9. Solez K, Axelsen RA, Benediktsson H, et al. International standardization of criteria for the histologic diagnosis of renal allograft rejection: The Bannf vvorking classification of kidney transplant pathology. Kidney Int 1993;44:411-422.
10. Solez K, Racusen L, Rayner D, Olsen S, Halloran P. The Banff schema four years later. Transplant Proc 1996;28:450-452.
11. Colvin RB, CohenJJ, Harrington JT, Madias NE, Zusman CJ. The renal allograft biopsy. Kidney Int 1996;50:1069-1082.
12. Cosyns JP, Malaise J, Hanique G, et al. Lesions in donor kidneys: nature, incidence, and influence on graft function. Transplant Int 1998;11 (1):22-27.
13. Szanya J, Szakaly P, Magyarlaki T, Balogh Z, Nagy J, Nagy KK. Predictive morphological findings in "zero-hour" biopsies of renal allografts. Açta Chir Hung 1997;36(1-4):346-348.
14. Nyberg G, Hedman L, Blohme I, Svalander C. Morphologic findings in baseline kidney biopsies from living related donors. Transplant Proc 1992;24(1):355-356.
15. Rosenberg HG, Martinez PS, Vaccarezza AS, Martinez LV. Morphological findings in 70 kidneys of living donors for renal transplant. Pathol Res Pract 1990;186(5):619-624.
16. Wang HJ, Kjellstrand CM, Cockfield SM, Solez K. On the influence of sample size on the prognostic accuracy and reproducibility of renal transplant biopsy. Nephrol Dial Transplant 1998;13:165-172.
17. Andersen CB, Ladefoged SD, Larsen S. Acute kidney graft rejection. A morphological and immunohistological study on "zero hour" and follow-up biopsies with special emphasis on cellular infiltrates and adhesion molecules. APMIS 1994; 102:23-37.
18. Perloff LJ, Goodloe S, Jenis EH, Light JA, Spees EK. Value of one hour renal allograft biopsy. Lancet 1973;2:1294-1295.
19. Dunnill MS. Histopathology of renal allograft rejection. İn Morris PJ (ed), Kidney Transplantation principles and practise (4 nd ed). WB Saunders, Philadelphia 1994, pp 266-285.
20. Croker BP, Ramos EL. Pathology of renal allograft. İn: Tisher CC, Brenner BM (eds) Renal Pathology, with clinical and functional correlations (2 nd ed). JB Lippincott Company Philadelphia 1993, pp 1591-1640.
21. Mihatsch MJ, Gudat F, Ryffel B, Thiel G. Cyclosporine nephropathy. İn: Tisher CC, Brenner BM (eds) Renal Pathology, with clinical and functional correlations (2 nd ed). Philadelphia, JB Lippincott Company 1993, pp 1641-1681.
22. Isonemi H, Von VVİllebrand E, Krogerus L, Taskinen E, Ahonen J, Hayry P. The effect of donor age on kidney graft function and histopathological findings. Transplant Proc 1992;24:328-329.
23. Rao VK, Kasiske BL, Odlund MD, Ney AL, Andersen RC. İnfluence of kadaver donor age on posttransplant renal function and graft outcome. Transplantation 1990;49:91-95.