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Histopathological diagnoses revealed by indication-based renal allograft biopsies: a retrospective analysis

Yıl 2023, Cilt: 9 Sayı: 5 - September 2023, 1240 - 1244, 04.09.2023
https://doi.org/10.18621/eurj.1330877

Öz

Objectives: Although there have been several advances in post-solid organ transplantation immunosuppression medications over the last two decades, the long-term survival of renal allografts did not significantly improve. Renal allograft biopsy is a helpful tool for determining the cause of graft dysfunction and adjusting patient management.

Methods: Patients who received kidney transplantation and underwent allograft biopsy in Istinye University Hospital between January 2017 and January 2023 constituted the target population of this study. Demographic parameters, clinical data and biopsy indications, and histopathological assessment results of the patients were retrospectively analyzed.

Results: Overall, 74 patients were included. The histopathology results included acute T-Cell mediated rejection (TCMR) (n = 15, 20%), tubular atrophy/chronic allograft nephropathy (IFTA) (n = 11, 15%), calcineurin inhibitor (CNI) toxicity (n = 2, 3%), chronic antibody-mediated rejection (ABMR) (n = 2, 3%), borderline pathology (n = 10, 13.5%), normal histology (n = 5, 6.5%), transplant glomerulopathy (TG) (n = 5, 6.5%), acute ABMR (n = 4, 5%), acute tubular necrosis (n = 7, 9%), polyomavirus nephropathy (n = 3, 4%) and non-specific changes (n = 10, 13.5%). The C4d was positive in 12% (n = 9) of the graft biopsies. In 73% (n = 54) of cases, the treatment strategy was changed based on biopsy results. Among all patients, 19 (25.6%) lost their grafts during follow-up.

Conclusions: According to the histopathological analysis results, acute TCMR, IFTA, and borderline pathology were the most common causes of renal graft dysfunction. Renal allograft biopsy led to a remarkable change in treatment strategies in a significant number of cases.

Kaynakça

  • 1. Burns T, Fernandez R, Stephens M. The experiences of adults who are on dialysis and waiting for a renal transplant from a deceased donor: a systematic review. JBI Database System Rev Implement Rep 2015;13:169-211.
  • 2. Cho H, Baek CH, Park SK, Kim H, Go H. Significance of C4d expression in peritubular capillaries concurrent with microvascular inflammation in for-cause biopsies of ABO-incompatible renal allografts. Kidney Res Clin Pract 2023 May 12. doi: 10.23876/j.krcp.22.221.
  • 3. Rodriguez-Ramirez S, Al Jurdi A, Konvalinka A, Riella LV. Antibody-mediated rejection: prevention, monitoring and treatment dilemmas. Curr Opin Organ Transplant 2022;27:405-14.
  • 4. Parajuli S, Joachim E, Alagusundaramoorthy S, Blazel J, Aziz F, Garg N, et al. Subclinical antibody-mediated rejection after kidney transplantation: treatment 0utcomes. Transplantation 2019;103:1722-29.
  • 5. Lim MA, Bloom RD. How to maximize graft survival. Curr Opin Organ Transplant 2023;28:55-63.
  • 6. Beadle J, Papadaki A, Toulza F, Santos E, Willicombe M, McLean A, et al. Application of the Banff Human Organ Transplant Panel to kidney transplant biopsies with features suspicious for antibody-mediated rejection. Kidney Int 2023;104:526-41.
  • 7. Tsai SF, Chen CH, Shu KH, Cheng CH, Yu TM, Chuang YW, et al. Current safety of renal allograft biopsy with indication in adult recipients: an observational study. Medicine (Baltimore) 2016;95:e2816.
  • 8. Moein M, Papa S, Ortiz N, Saidi R. Protocol biopsy after kidney transplant: clinical application and efficacy to detect allograft rejection. Cureus 2023;15:e34505.
  • 9. Artiles A, Domínguez A, Subiela JD, Boissier R, Campi R, Prudhomme T, et al. Kidney transplant outcomes in elderly population: a systematic review and meta-analysis. Eur Urol Open Sci 2023;51:13-25.
  • 10. McDonald S, Russ G, Campbell S, Chadban S. Kidney transplant rejection in Australia and New Zealand: relationships between rejection and graft outcome. Am J Transplant 2007;7:1201-8.
  • 11. Parajuli S, Aziz F, Garg N, Panzer SE, Joachim E, Muth B, et al. Histopathological characteristics and causes of kidney graft failure in the current era of immunosuppression. World J Transplant 2019;9:123-33.
  • 12. Mohammadi Afrakoti M, Nassiri AA, Hakemi MS, Afroughe A, Ganji MR. The renal histopathological findings in patients with renal allograft dysfunction: a retrospective single center study. Iran J Kidney Dis 2023;17:168-73.
  • 13. Hogan TF, Borden EC, McBain JA, Padgett BL, Walker DL. Human polyomavirus infections with JC virus and BK virus in renal transplant patients. Ann Intern Med 1980;92:373-8.
  • 14. Sharma R, Zachariah M. BK Virus Nephropathy: prevalence, impact and management strategies. Int J Nephrol Renovasc Dis 2020;13:187-92.
  • 15. Tamargo CL, Kant S. Pathophysiology of rejection in kidney transplantation. J Clin Med 2023;12:4130.
  • 16. Szumilas K, Wilk A, Wiśniewski P, Gimpel A, Dziedziejko V, Kipp M, et al. Current Status Regarding Immunosuppressive Treatment in Patients after Renal Transplantation. Int J Mol Sci 2023;24:10301.
  • 17. Cimen S, Geldenhuys L, Guler S, Imamoglu A, Molinari M. Impact of specimen adequacy on the assessment of renal allograft biopsy specimens. Braz J Med Biol Res 2016;49:e5301.
Yıl 2023, Cilt: 9 Sayı: 5 - September 2023, 1240 - 1244, 04.09.2023
https://doi.org/10.18621/eurj.1330877

Öz

Kaynakça

  • 1. Burns T, Fernandez R, Stephens M. The experiences of adults who are on dialysis and waiting for a renal transplant from a deceased donor: a systematic review. JBI Database System Rev Implement Rep 2015;13:169-211.
  • 2. Cho H, Baek CH, Park SK, Kim H, Go H. Significance of C4d expression in peritubular capillaries concurrent with microvascular inflammation in for-cause biopsies of ABO-incompatible renal allografts. Kidney Res Clin Pract 2023 May 12. doi: 10.23876/j.krcp.22.221.
  • 3. Rodriguez-Ramirez S, Al Jurdi A, Konvalinka A, Riella LV. Antibody-mediated rejection: prevention, monitoring and treatment dilemmas. Curr Opin Organ Transplant 2022;27:405-14.
  • 4. Parajuli S, Joachim E, Alagusundaramoorthy S, Blazel J, Aziz F, Garg N, et al. Subclinical antibody-mediated rejection after kidney transplantation: treatment 0utcomes. Transplantation 2019;103:1722-29.
  • 5. Lim MA, Bloom RD. How to maximize graft survival. Curr Opin Organ Transplant 2023;28:55-63.
  • 6. Beadle J, Papadaki A, Toulza F, Santos E, Willicombe M, McLean A, et al. Application of the Banff Human Organ Transplant Panel to kidney transplant biopsies with features suspicious for antibody-mediated rejection. Kidney Int 2023;104:526-41.
  • 7. Tsai SF, Chen CH, Shu KH, Cheng CH, Yu TM, Chuang YW, et al. Current safety of renal allograft biopsy with indication in adult recipients: an observational study. Medicine (Baltimore) 2016;95:e2816.
  • 8. Moein M, Papa S, Ortiz N, Saidi R. Protocol biopsy after kidney transplant: clinical application and efficacy to detect allograft rejection. Cureus 2023;15:e34505.
  • 9. Artiles A, Domínguez A, Subiela JD, Boissier R, Campi R, Prudhomme T, et al. Kidney transplant outcomes in elderly population: a systematic review and meta-analysis. Eur Urol Open Sci 2023;51:13-25.
  • 10. McDonald S, Russ G, Campbell S, Chadban S. Kidney transplant rejection in Australia and New Zealand: relationships between rejection and graft outcome. Am J Transplant 2007;7:1201-8.
  • 11. Parajuli S, Aziz F, Garg N, Panzer SE, Joachim E, Muth B, et al. Histopathological characteristics and causes of kidney graft failure in the current era of immunosuppression. World J Transplant 2019;9:123-33.
  • 12. Mohammadi Afrakoti M, Nassiri AA, Hakemi MS, Afroughe A, Ganji MR. The renal histopathological findings in patients with renal allograft dysfunction: a retrospective single center study. Iran J Kidney Dis 2023;17:168-73.
  • 13. Hogan TF, Borden EC, McBain JA, Padgett BL, Walker DL. Human polyomavirus infections with JC virus and BK virus in renal transplant patients. Ann Intern Med 1980;92:373-8.
  • 14. Sharma R, Zachariah M. BK Virus Nephropathy: prevalence, impact and management strategies. Int J Nephrol Renovasc Dis 2020;13:187-92.
  • 15. Tamargo CL, Kant S. Pathophysiology of rejection in kidney transplantation. J Clin Med 2023;12:4130.
  • 16. Szumilas K, Wilk A, Wiśniewski P, Gimpel A, Dziedziejko V, Kipp M, et al. Current Status Regarding Immunosuppressive Treatment in Patients after Renal Transplantation. Int J Mol Sci 2023;24:10301.
  • 17. Cimen S, Geldenhuys L, Guler S, Imamoglu A, Molinari M. Impact of specimen adequacy on the assessment of renal allograft biopsy specimens. Braz J Med Biol Res 2016;49:e5301.
Toplam 17 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Genel Cerrahi
Bölüm Original Article
Yazarlar

Eryigit Eren 0000-0001-6705-4095

Mehmet Tokac 0000-0002-5651-1286

Alaaddin Aydın 0000-0001-8660-5673

Taylan Şahin 0000-0002-9888-6625

Hikmet Bora Uslu 0000-0001-8464-0977

Selman Alkan 0000-0003-2974-7610

Ayhan Dinçkan 0000-0003-1395-333X

Erken Görünüm Tarihi 29 Ağustos 2023
Yayımlanma Tarihi 4 Eylül 2023
Gönderilme Tarihi 22 Temmuz 2023
Kabul Tarihi 28 Ağustos 2023
Yayımlandığı Sayı Yıl 2023 Cilt: 9 Sayı: 5 - September 2023

Kaynak Göster

AMA Eren E, Tokac M, Aydın A, Şahin T, Uslu HB, Alkan S, Dinçkan A. Histopathological diagnoses revealed by indication-based renal allograft biopsies: a retrospective analysis. Eur Res J. Eylül 2023;9(5):1240-1244. doi:10.18621/eurj.1330877

e-ISSN: 2149-3189 


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