Acta Chirurgica 36. (1997)
Contents
"Zero-hour" biopsies ("wedge-biopsies" of 3x5 mm size from the upper pole of the grafts) were performed at the end of cold ischaemic time. No "zero-hour" biopsies complications were observed. 50 consecutive graft rebiopsies were performed in 33/65 transplanted patients to follow their graft complications during 336 days in average. Indications of graft rebiopsies included: 1. Delayed graft function for more than 7 days, 2. Steroid resistant acute rejection, 3. No adequate response to anti-rejection therapy, 4. Increasing serum creatinin without signs of rejection. Immunosuppression protocol included: 1. Sandimmun or Neoral (10 mg/kg/die) monitored by serum cyclosporin A from day 8.; 2. Azathioprin (1-2 mg/kg/die); 3. Methylprednisolon (1 mg/kg/die, sequentially reduced to 0.15 mg/kg/die from day 61.); 4. Prophylactic anti-lymphocyte globulin (ALG) or anti-thymocyte globulin (ATG). Acute rejection therapy: 3-5x500 mg methylprednisolon, rebiopsy was performed if there was no response, ALG or ATG if rebiopsy proved grade II—III rejection. Morphological analysis was done by light microscopy, immunofluorescence (IgG, IgA, IgM, C3 and MAC [membrane attack complex]) and transmission electron microscopy (ТЕМ) using standard techniques 1. Acute and/or chronic rejections, cyclosporin nephropathy, acute tubular necrosis were diagnosed on the basis of graft biopsies according to the Banff criteria [5]. Graft thrombosis was suspected by biopsy findings of renal infarction, proved by Dopplerultrasonography and macroscopic examination of the kidneys after nephrectomy. Clinical follow up was performed by the members of the transplantation team checking of the following parameters regularly: 1. Full laboratory status, 2. Physical examination, 3. Blood pressure, 4. Throat/urine bacteriology, 5. Chest X-ray, 6. ECG, 7. Abdominal ultrasonography. Clinical information was available about donor/recipient age and sex, HLA-B, DR mismatch, pretransplant kidney disease and hemodialysis time of the recipient, blood group of the donor/recipient, periods of handling time, warm/cold ischaemia and non-graft-related clinical complications, treatments and lethal complications. Definitions: delayed graft function (DGF) was defined as an initial need of hemodialysis. "Good" renal function was classified if the patient had not returned to hemodialysis or died with good renal function during the follow up period. Results Early graft function was monitored during the first two posttransplant months in recipients with renal allografts of different "zero-biopsy" morphology. Higher serum creatinin (266 [100-530] pM/L) was observed in recipients with arteriosclerosis (group 1) (p < 0.05) and tubulointerstitial nephritis grafts (group 4) (277 [133-600] pM/L) (statistically not evaluatable). Higher number of non-viabile grafts (21.4%) (p < 0.05) was present in acute tubular necrosis (ATN - group 3). There were no differences in the frequency of delayed graft function (DGF) (28-30%), but a significantly longer DGF time (18.5 days) (p < 0.05) was found in ATN - group 3. All groups were compared to group 1 with normal morphological findings.