Kidney transplantation is the most effective treatment for end-stage renal disease and is the treatment of choice for uremia.
Although the 1-year survival rate of kidney transplant recipients has improved by reaching over 90%, however, the survival rate at 10 years and beyond is still unsatisfactory. According to authoritative statistics from the United States, the 10-year survival rates for relative kidney transplant recipients and transplanted kidneys are 72.4% and 55.2%, respectively, while cadaveric donor kidneys are even lower at 57.9% and 36.4%. Therefore, it is internationally recommended to use regular transplant kidney biopsies to keep track of the health status of the transplanted kidney, determine the presence of early rejection and the presence of drug nephrotoxicity, so as to scientifically adjust the immunosuppression protocol and improve the survival rate of kidney transplant recipients and transplanted kidneys. This concept has been slowly accepted by major transplant centers in China, and puncture biopsy plays a role in ensuring the long-term survival of the transplanted kidney.
1. Puncture biopsy is the most reliable method
Many causes can lead to hypofunction of the transplanted kidney, for example, various types of rejection, nephrotoxicity of drugs, hypertension, diabetes, tuberculosis infection, BK virus infection, etc. These etiologies, however, are often extremely difficult to distinguish clearly based on clinical symptoms, medical history and laboratory tests alone, even for very experienced kidney transplant specialists, and require a clear pathological diagnosis of the transplanted kidney.
For different etiologies, different treatment modalities, or even the exact opposite, are required. For example, drug toxicity hyperalgesia requires a reduction in medication, while in case of rejection, the dose of medication needs to be increased. It is also often difficult to accurately determine between drug toxicity and rejection, which can often lead to serious consequences, or even the complete loss of the transplanted kidney, if not treated properly.
Subclinical rejection is a common clinical rejection reaction, named because the patient does not have the symptoms of typical rejection, but the pathological process of rejection has been initiated inside the transplanted kidney, the infiltration and destruction of lymphocytes in the kidney begins, and after several months or even years, slowly the function of the transplanted kidney will be reduced, and a large number of chronic rejection reactions are the gradual evolution of subclinical rejection A large number of chronic rejection reactions are the gradual evolution of subclinical rejection. Once the chronic rejection stage is reached, it is very difficult to save the kidney function. Therefore, regular puncture biopsy of the transplanted kidney is highly recommended internationally for early detection of potential lesions.
2. Puncture biopsy is a safe method
The main complications of transplant kidney biopsy include hematuria, bleeding and leakage, but the incidence of these conditions is extremely low and the safety of the procedure has been proven by a large number of puncture biopsy clinics. Puncture biopsy has become an internationally accepted and recognized method for the diagnosis of kidney disease.
3.Transplant kidney puncture biopsy procedure
The recipient needs to be hospitalized for 1-2 days. After checking the coagulation function without abnormalities in the outpatient clinic, interventional ultrasound guided transplant kidney puncture biopsy is performed after admission. Generally, a 16G puncture biopsy needle is used to take 2 strips of kidney tissue, about 1.5~50px long, from 2 different parts of the upper and middle of the transplanted kidney. The ideal puncture biopsy tissue should include parts of the transplanted kidney cortex and medullary tubular area, which can basically reflect the state of the transplanted kidney. After the recipient’s puncture biopsy, sandbag pressure bandage, absolute bed rest for 6 hours, routine oral hemostatic drugs for 1 day, optional routine oral hemostatic drugs for 1 day, and oral antibiotics for 3 days. If there is no special treatment on the second day after surgery, you can be discharged from the hospital.
4. Interpretation of transplanted kidney puncture biopsy results
The current global transplant kidney puncture pathology results mainly use Banff diagnostic criteria, including.
(1) normal.
(2) hyperacute rejection.
(3) critical changes.
(4) Acute rejection (grade I, II and III)
(5) chronic rejection (grades I, II, and III)
(6) other changes (lesions not related to rejection) such as drug nephrotoxicity, viral infection, etc.
5. Treatment of transplanted kidney puncture biopsy results
According to the puncture pathology results, if there is no special reaction, follow-up observation is sufficient.
If rejection is found, hormone shock therapy has better effect on acute cell-mediated rejection; systemic lymphatic irradiation has better effect on acute antibody-mediated rejection, and is safe and reliable; for chronic graft nephropathy, the main thing is to convert the immunosuppressant program, but the general treatment effect is not good; for drug toxicity damage of immunosuppressant, the main thing is to reduce the dose or adjust the immunosuppressant program, etc.
6.Regular puncture biopsy to protect life and health
In recent years, major transplantation centers around the world have generally adopted the method of regular transplantation puncture biopsy to ensure the health and safety of kidney transplant recipients, and the puncture biopsy of transplanted kidneys has become an essential item in the follow-up of kidney transplant recipients.
Since rejection of the transplanted kidney occurs 90% of the time within 1 year after transplantation, with the highest incidence occurring within 3 months after transplantation, doctors recommend that kidney transplant recipients receive regular puncture biopsies at 1 month, 3 months, 6 months and 1 year after transplantation to closely monitor the health status of the transplanted kidney, and then receive further medical advice according to the recipient’s condition.
In summary
Transplantation biopsy is a reliable and safe diagnostic method, and transplant recipients need not worry too much.