Böbrek transplant alıcılarında allograft biyopsisinin histopatolojik değerlendirilmesi ve komplikasyonları: Radyolojik görüntüleme açısından

Yıl 2020, Cilt: 11 Sayı: 4, 307 - 314, 30.09.2020

Belma Çevik

https://doi.org/10.18663/tjcl.672624

Öz

Amaç: Böbrek nakli, son dönem böbrek yetmezliği olan hastaların çoğunda tercih edilen tedavi yöntemi haline gelmiştir. Renal allogreft biyopsisi böbrek nakli disfonksiyonunun tanısında en önemli tekniktir. Bu çalışmada, radyolojik görüntüleme ışığında renal transplant hastalarında histopatolojik değerlendirme ve komplikasyon tipleri ve sıklığının araştırılması amaçlandı.
Gereç ve Yöntemler: Bu retrospektif çalışmada, Ocak 2000 ve Aralık 2007 tarihleri arasında böbrek biyopsisi yapılan renal transplantasyonlu hastaların histopatolojik biyopsi sonuçları, kalsinörin inhibitörü ilaç düzeyi ile toksisite gelişimi arasındaki ilişki açısından değerlendirildi. Ayrıca biyopsi ile ilişkili komplikasyonlar araştırıldı.
Bulgular: Toplam 386 hasta çalışmaya dahil edildi ve bu hastalara 843 biyopsi yapıldı. Doku miktarı 812 biyopside (% 96) yeterli, 6 biyopside (% 1) yetersiz ve 27 biyopside (% 3) sınırlı ancak histopatolojik değerlendirme için yeterli bulunmuştur. Akut ret, tübüler epitel hasarı ve kronik allogreft nefropati en sık konulan tanılardı. Biyopsilerin komplikasyonları 4 biyopside makroskopik hematüri (%0.57), 6 biyopside perirenal hematom (% 1) ve 1 biyopside arteriyovenöz fistül (% 0.15) idi.
Sonuç: Böbrek allogreft disfonksiyonunu değerlendirmek için nakil yapılan hastalarda böbrek biyopsisi çok düşük komplikasyon oranına sahip güvenli bir yöntemdir.

Anahtar Kelimeler

böbrek nakli, allogreft biyopsisi, kanama, arteryo-venöz fistül

Histopathologic evaluation and complications of allograft biopsy in renal transplant recipients: In terms of radiologic imaging

Öz

Aim: Renal transplantation has become the treatment of choice for most patients with end-stage renal disease. Renal allograft biopsy is the most important technique in diagnosis of renal transplant dysfunction. In the light of radiological imaging, we investigated histopathologic evaluation and types and incidence of complications in renal transplant patients.
Material and Methods: In this retrospective study, histopathological biopsy results of patients with renal transplantation who underwent renal biopsy between January 2000 and December 2007 were evaluated in terms of the relationship between calcineurin inhibitor drug level and toxicity development. In addition, biopsy related complications were investigated.
Results: In a total of 386 patients were included in the study and 843 biopsies were performed on these patients. The amount of tissue was adequate in 812 biopsies (96%), inadequate in 6 biopsies (1%) and of limited adequacy in 27 biopsies (3%) for histopathologic evaluation. Acute rejection, tubular epithelial injury and chronic allograft nephropathy were the most frequent diagnoses. Complications of the biopsies were macroscopic hematuria in 4 biopsies (0.5%), perirenal hematoma in 6 biopsies (1%), and arteriovenous fistula in 1 biopsy (0.1%).
Conclusion: Renal biopsy in transplant patients to evaluate the renal allograft dysfunction is a safe method with very low incidence rate of complications.

Anahtar Kelimeler

renal transplantation, allograft biopsy, bleeding, arteriovenous fistula

Kaynakça

• 1. Parfrey PS, Kuo YL, Hanley JA et al. The diagnostic and prognostic value of renal allograft biopsy. Transplantation 1984; 38: 586.
• 2. Silva DM, Garcia JP, Ribeiro AR et al. Utility of biopsy in kidney transplants with delayed graft function and acute dysfunction. Transplantation Proceedings 2007; 39: 376-7.
• 3. McWhinnie DL, Hughes D, Fuggle SV et al. Immunohistology or conventional histology for the diagnosis of renal allograft rejection. Transplant Proc 1989; 21: 1888.
• 4. Cynthia CN, Arthur HC. Pathology of Kidney transplantation. In: Danowitch GJ (Third edition). Hand book of kidney transplantation, Lippincott Williams&Wilkins, Philadelphia 2001, p:290-313.
• 5. McWhinnie DL, Thompson JF, Taylor HM et al. Morphometric analysis of cellular infiltration assessed by monoclonal antibody labelling in sequential human renal allograft biopsies. Transplantation 1986; 42: 352.
• 6. Sibley RK, Rynasiewicz J, Ferguson RM et al. Morphology of cyclosporine nephrotoxicity and acute rejection in patients immunosupressed with cyclosporine and prednisolon. Surgery 1983; 94: 225.
• 7. Duman S, Ozbek SS, Sen S et al. The risk evaluation of ultrasound guided renal biopsy in renal transplant recipients. Official Journal of the Turkish Society of Nephrology 2002; 11: 149-52.
• 8. Wilczek HE. Percutaneous needle biopsy of the renal allograft. A clinical safety evaluation of 1129 biopsies. Transplantation 1990; 50: 790-7.
• 9. Sodof JM, Vartaian RK, Olson JL et al. Histological corcodance of paried renal allograft biopsy cores. Transplantation 1995; 60: 1215.
• 10. Solez K, Colvin RB, Racusen LC et al. Banff’ 05 Meeting Report: Differential Diagnosis of Chronic Allograft Injury and Elimination of Chronic Allograft Nefropathy (‘CAN’). American Journal of Transplantation 2007; 518-26.
• 11. Helanterӓ I, Ortiz F, Helin H et al. Timing and value of protocol biopsies in well-matched kidney transplant recipients - a clinical and histopathologic analysis. European Society for Organ Transplantation 2007; 20: 982-90.
• 12. Mao Y, Chen J, Shou Z et al. Clinical significance of protocol biopsy at one month posttransplantation in deceased-donor renal transplantation. Transplant Immunology 2007; 17: 211-4.
• 13. Nicholson ML, Wheatley TJ, Doughman TM et al. A prospective randomized trial of three different sizes of core-cutting needle for renal transplant biopsy. Kidney International, 2000; 58: 390-5.
• 14. Mahoney MC, Racadio JM, Merhar GL et al. Safety and efficacy of kidney transplant biopsy: Tru-cut needle vs sonographically guided biopty gun. AJR 1993; 160: 325-6.
• 15. Boyvat F, Tarhan NC, Coskun M et al. Comparison of two biopsy techniques for renal transplant assessment. Transplantation Proceedings 1998; 30: 777-9.
• 16. Mansy H, Khalil A, Bafaqeeh M et al. Transplant nephrectomy for a large A-V fistula following renal biopsy. Nephron 1995; 71: 481.
• 17. Healty and Public Policy Committee, American Collage of Physicians. Clinical competence in percutaneous renal biopsy. Ann Intern Med 1988; 108: 31.
• 18. Kiss D, Landman J, Mıhatsch M et al. Risk and benefits of graft biopsy in renal transplantation under cyclosporin-A. Clin Nephrol 1992; 38: 132.
• 19. Perico N, Ruggenenti P, Gaspari F et al. Daily renal hypoperfusion induced by cyclosporine in patients with renal transplantation. Transplantation 1992; 54: 56-60.
• 20. He X, Johnston A. Variable cyclosporine exposure: A risk factor for chronic allograft nephropathy and graft loss ? Transplantation Proceedings 2004; 36: 1321-6.
• 21. Liptak P, Ivanyi B. Primer: Histopathology of calcineurin-inhibitor toxicity in renal allografts. Nat Clin Pract Nephrol 2006; 2: 398-404.