|
|
 |
 |
|
|
| Clinicopathologic Correlation between Early and Slow Graft Function in Renal Transplant Recipients |
|
|
|
| Division of Nephrology, Kangnam St. Mary's Hospital,The Catholic University of Korea, Seoul, Korea |
|
|
|
|
|
Recovery of graft function after renal transplantation can be divided into early graft function (EGF), slow graft recovery (SGF) and delayed graft function (DGF) according to the recovery state of graft function. Until now, it is uncertain whether there is histologic difference between EGF and SGF, and difference of long-term prognosis between two groups. Our study was performed to evaluate the clinicopathologic correlation between EGR and SGR. Total 294 patients were included. Male was 183 and female was 111. The average age at renal transplantation was 38 (13〜63), and donor source was 226 living (76.9%) and 68 cadaver (23.1%).
EGF was defined when serum creatinine levels were below 1.2 mg/dl, and SGF was defined when serum creatinine levels were 1.2 or above 1.2 mg/dl at 2 weeks after renal transplantation. Graft biopsy was performed at 14 days after renal transplantation regardless of graft function, and pathologic classification was made by Banff schema.
Clinical classification showed 116 cases of EGF (39.5%), 121 cases SGF (41.2%) and 18 cases of DGF (6.1%). Others were acute rejection (n=24, 11.6%) and of cyclosporine (CsA) nephrotoxicity (n=5, 1.7%).
Pathologic classification of graft biopsy revealed 103 cases of normal (35%), 120 cases of borderline (40.8%) and 36 cases of acute rejection (12.2%). Other cases showed CsA nephrotoxicity (n=10, 3.4%), acute tubular necrosis and glomerulitis (n=25, 8.5%). Pathologic classification between EGF and SGF group showed normal (48.3% vs. 33.9%, P<0.05), borderline (38.8% vs. 40.5%, P>0.05) and AR (3.4% vs. 14.1%, P<0.05).
Five-year-graft survival and graft function in patients with borderline pathology showed significant difference between EGF and SGF. The recipients with borderline pathology showed 100% in the EGF group and 87.7% in the SGF group (P<0.05). Serum creatinine levels (at 3 months, 6 months, 1 year, and 3 years after renal transplantation) were also significantly increased in the SGF group with borderline pathology as compared with the EGF group with borderline pathology (P<0.05). Semiquantitative RT-PCR (Fas-ligand, granzyme B and perforin) revealed different results between EGF and SGF groups. In the EGF group, there was no significant difference between normal and borderline pathology, but SGF group showed significant increase of these pro-apoptotic genes in the borderline pathology as compared with the normal pathology.
In conclusion, the patients with SGF and borderline pathology represent the activated immune state, and anti-rejection treatment might be needed in these patients. |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
戻 る ページの先頭 |
|
|
|
|
|
