Nierentransplantatbiopsie

Die Nierenbiopsie ist ein wichtiges diagnostisches Hilfsmittel für das Verstehen des Verlaufes nach Nierentransplantation. Neben Nachweis oder Ausschluss einer Rejektion können auch viele Differenzialdiagnosen reichend von einer Rekurrenz der Grunderkrankung über Infektionen (Polyoma-, Zytomegalie- und Hantavirus), Tumoren (Lymphom, Leichtketteninfiltration) oder weitere prärenale (Nierenarterienstenose) bzw. postrenale Ursachen diagnostiziert oder ausgeschlossen werden. Die Banff-Klassifikation in der aktuellen Fassung von 2013 dient dabei v. a. zur Klassifizierung von unterschiedlichen Abstoßungsarten und chronischen Veränderungen [1]. Komplikationen der Transplantatbiopsie sind selten, sodass dieses Instrument für die Diagnostik genutzt werden sollte. Kontraindikationen für eine Biopsie stellen nur ein nicht einstellbarer Hypertonus und eine ausgeprägte Blutungsneigung dar.

• Literatur

• 1 Haas M, Sis B, Racusen LC et al Banff 2013 meeting report: inclusion of c4d-negative antibody-mediated rejection and antibody-associated arterial lesions. Am J Transplant 2014; 14: 272-283
• 2 Racusen LC, Solez K, Colvin RB et al The Banff 97 working classification of renal allograft pathology. Kidney Int 1999; 55: 713-723
• 3 Preuss S, Kuechle C, Wagenpfeil S et al Retrospective Analysis of Ultrasound-Detected Bleeding Complications after Ultrasound-Guided Transcutaneous Kidney Biopsies. Ultrasound Med Biol 2017; 43: 153-162
• 4 Kasiske BL, Zeier MG, Chapman JR et al KDIGO clinical practice guideline for the care of kidney transplant recipients: a summary. Kidney Int 2010; 77: 299-311
• 5 Bartel G, Schwaiger E, Bohmig GA. Prevention and treatment of alloantibody-mediated kidney transplant rejection. Transpl Int 2011; 24: 1142-1155
• 6 Sautenet B, Blancho G, Buchler M et al One-year Results of the Effects of Rituximab on Acute Antibody-Mediated Rejection in Renal Transplantation: RITUX ERAH, a Multicenter Double-blind Randomized Placebo-controlled Trial. Transplantation 2016; 100: 391-399
• 7 Waiser J, Duerr M, Schonemann C et al Rituximab in Combination With Bortezomib, Plasmapheresis, and High-Dose IVIG to Treat Antibody-Mediated Renal Allograft Rejection. Transplant Direct 2016; 2: e91
• 8 Barnett AN, Hadjianastassiou VG, Mamode N. Rituximab in renal transplantation. Transpl Int 2013; 26: 563-575
• 9 Lee J, Kim BS, Park Y et al The Effect of Bortezomib on Antibody-Mediated Rejection after Kidney Transplantation. Yonsei Med J 2015; 56: 1638-1642
• 10 Eskandary F, Bond G, Regele H et al Late Antibody-Mediated Rejection in a Large Prospective Cross-Sectional Study of Kidney Allograft Recipients--Preliminary Results of the Screening Phase of the BORTEJECT Trial. Clin Transpl 2014; 189-195
• 11 Woodle ES, Shields AR, Ejaz NS et al Prospective iterative trial of proteasome inhibitor-based desensitization. Am J Transplant 2015; 15: 101-118
• 12 Gupta G, Abu Jawdeh BG, Racusen LC et al Late antibody-mediated rejection in renal allografts: outcome after conventional and novel therapies. Transplantation 2014; 97: 1240-1246
• 13 Tran D, Boucher A, Collette S et al Eculizumab for the Treatment of Severe Antibody-Mediated Rejection: A Case Report and Review of the Literature. Case Rep Transplant 2016; 2016 9874261
• 14 Stegall MD, Diwan T, Raghavaiah S et al Terminal complement inhibition decreases antibody-mediated rejection in sensitized renal transplant recipients. Am J Transplant 2011; 11: 2405-2413
• 15 Montgomery RA, Zachary AA, Racusen LC et al Plasmapheresis and intravenous immune globulin provides effective rescue therapy for refractory humoral rejection and allows kidneys to be successfully transplanted into cross-match-positive recipients. Transplantation 2000; 70: 887-895
• 16 Zheng J, Xue W, Qing X et al Treatment of Biopsy-Proven Acute Antibody-Mediated Rejection Using Thymoglobulin (ATG) Monotherapy and a Combination of Rituximab, Intravenous Immunoglobulin, and Plasmapheresis: Lesson Learned from Primary Experience. Clin Transpl 2014; 223-230
• 17 Gatault P, Kamar N, Büchler M et al Reduction of extended-release tacrolimus dose in low immunological risk kidney transplant recipients increases risk of rejection and appearance of DSA - a randomized study. Am J Transplant. 09.11.2016 [Epub ahead of print]
• 18 Meehan SM, Siegel CT, Aronson AJ et al The relationship of untreated borderline infiltrates by the Banff criteria to acute rejection in renal allograft biopsies. J Am Soc Nephrol 1999; 10: 1806-1814
• 19 Casadei DH, del CRM, Opelz G et al A randomized and prospective study comparing treatment with high-dose intravenous immunoglobulin with monoclonal antibodies for rescue of kidney grafts with steroid-resistant rejection. Transplantation 2001; 71: 53-58
• 20 Webster AC, Pankhurst T, Rinaldi F et al Monoclonal and polyclonal antibody therapy for treating acute rejection in kidney transplant recipients: a systematic review of randomized trial data. Transplantation 2006; 81: 953-965