Long-term functioning of kidney grafts
Purpose of the study. to study the morphological changes of long-functioning kidney transplants and determine the main causes of transplant dysfunction.
Materials and methods. A total of 52 recipients aged 20 to 70 years were analyzed retrospectively at different times after transplant surgery (5 to 22 years).Morphological changes in the kidney transplant are comparable according to light microscopy. The morphological changes in the graft were studied in the initial and long-term period. Morphological studies were conducted in monitoring mode.
Results. In the early period after transplantation, ischemic injuries, primary graft function, and episodes of acute rejection were taken into account. In the distant period, morphological changes were evaluated in accordance with the recommendations of the Banff-classification.
When analyzing long-term results, antigendependent (immune) and antigen-independent (visible) factors that affect the renal transplant are distinguished. The main clinical and laboratory indicators of allografts dysfunction are increased creatinine and proteinuria.
In antigen-dependent forms (cellular, humoral and mixed rejection), humoral rejection is the most common (25%) allografts dysfunction.
Antigen-independent forms of dysfunction (streptococcal infection 25%, inflammatory diseases 19,2%, recurrent pathology 3,8%, signs of cyclosporine nephrotoxicity in combination with other forms was found in 59,2%, nephrosclerosis 65,4%).
Conclusions. The data obtained suggest that antigen-dependent (immune) factors, and in particular humoral rejection, are the most common cause of allografts dysfunction, and antigenindependent factors contribute to the progression of chronic rejection and the development of nephrosclerosis.
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