Acta Chirurgica 36. (1997)
Contents
Acta Chirurgica Hungarica, 36 (1-4) pp. 346-348 (1997) PREDICTIVE MORPHOLOGICAL FINDINGS IN "ZERO-HOUR" BIOPSIES OF RENAL ALLOGRAFTS Jolán Szánya, P. Szakály*, T. Magyarlaki, Zita Balogh, Judit Nagy** and K. Kalmár Nagy* Department of Clinical Chemistry, Transplantation Unit of the 1st Department of Surgery, Neprology Center of the 2nd Department of Internal Medicine, University Medical School of Pécs H-7624 Pécs, Ifjúság útja 13, Hungary "Zero-hour" biopsies of 65 donors have been performed since 1994. Donor kidneys were categorized into five groups based on the morphological findings in "zero-hour" biopsies. No morphological abnormalities were found in 38% of the cases (group 1). Arteriosclerosis was present in 31% of donor kidneys (group 2). Specific morphological alterations, i. e. acute tubular necrosis [21.5%], tubulointerstitial nephritis [6.2%] or glomerulonephritis [3.1%] were detectable in the cases remained (group 3-5). During an average of 336 posttransplant days clinical and histological follow up was performed (50 rebiopsies). Statistical data of mismatch (1,4-2,0), average of donor/recipient age (35-42 years), cold and warm ischaemic time (1290 and 66 min) were comparable in all groups. According to our obseivations: 1. higher creatinin was found in grafts with arteriosclerosis (group 2) (p < 0.05), 2. there were more non-viabile grafts and longer period of delayed graft function in acute tubular necrosis (group 3), 3. higher creatinin, rejections with the need of rehemodialysis were observed in four cases of tubulointerstitial nephritis (TIN-group 4). Glomerulonephritis (GN-group 5) grafts had only delayed graft function, however these groups were few for statistical evaluation. Biopsy complication in 1/115 cases was found (rebiopsy induced kidney haemorrhage). In conclusion, "zero-hour" biopsies can be useful and safe tools to predict early graft function. Besides "zero-hour" biopsies help the histological interpretation of consecutive graft rebiopsies. Introduction Early graft biopsies (called as "zero-hour" or "one-hour" biopsies) have been performed since 1968 as they seemed to serve as early reliable indicator of the status of the transplanted kidney [4]. Controversial results are published about the possible predictive value of these biopsies. In one hand its predictive role is questioned in early rejection [4], early and late graft function [1]. On the other hand it is suggested for prediction of graft loss [2]. Consensus has bee created that these early graft biopsies are useful tools for subsequent biopsy interpretation! [1, 3, 4]. The aim of this study is to introduce our observations on "zero-hour" biopsies and to reevaluate its role in clinical transplantation. Materials and Methods During the period of 1994-1996, 67 pretransplant "zero-hour" biopsies (one from a nonheart-beating donor, 66 from cadaver donors) were studied. 65 out of 67 grafts were transplanted (one with severe arteriosclerosis involving also the renal artery and one because of renal cell cancer with otherwise normal renal histology were excluded). 0231-4614 /97/$ 5.00© 1997 Akadémiai Kiadó, Budapest