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在延迟移植功能的协议活检中,从脑死亡的捐赠者移植脏

Amanda Ahlmark¹, Ville Sallinen¹, Anne Räisänen-Sokolowski²

¹Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.

Clinical transplantation

|July 15, 2025

概括

在移植中延迟的移植功能 (DGF) 通常导致急性排斥. 虽然第一次活检至关重要,但后来的活检仅在10%的病例中显示出拒绝,这表明需要重新评估当前的活检指南.

科学领域:

腎臟病學 (nephrology) 是一種醫學專業.
移植手术移植手术
免疫学免疫学免疫学

背景情况:

延迟移植功能 (DGF) 影响了三分之一的已故捐赠移植接受者,增加了急性排斥风险.
目前的指导方针建议对DGF脏进行序列性协议活检,基于较旧的免疫抑制数据.
急性排斥率的下降需要重新评估常规移植后协议活检的实用性.

研究的目的:

评估在移植后的第一个月内对死去的捐赠接受者与DGF.DGF.DGF.DGF.DGF.DGF.DGF.DGF.DGF的已故捐赠接受者进行序列协议活检的诊断产量.
根据现代免疫抑制方案,确定DGF脏中急性排斥事件的发生率和时间.
在当前免疫抑制策略的背景下,重新评估协议活检的临床相关性.

主要方法:

从678名已故的捐赠接受者获得DGF的1022个协议活检的回顾性分析 (2006-2023年).
所有受试者都接受了皮质类固醇诱导;一些受试者接受了抗胸细胞球蛋白或巴西利西马布.
移植后的第一个月内采取的活检的组织学审查.

主要成果:

在678名接受者 (26%) 中,有178人经历了急性排斥,主要是在移植后7-10天内.
在没有在第一次活检时被拒绝的病例中,随后的活检显示了10%的病例被拒绝.
献体特异性抗体与更高的抗体中介排斥率有关 (20%对1.3%).

结论:

移植后的初始活检对于早期检测DGF脏急性排斥至关重要.
拒绝发生在只有10%的DGF脏移植中,在第一个活检中没有拒绝.
活检的边界发现在大约三分之一的病例中进展到拒绝,突出了它们的意义.

关键词:

急性排斥急性排斥大脑死亡的捐赠者.延迟的移植功能延迟的移植功能组织学组织学腎臟移植腎臟移植协议活检活检

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