Zusammenfassung
Die Nierenbiopsie der transplantierten Niere spielt in der Nachsorge und Betreuung nierentransplantierter Patienten eine wichtige Rolle. Sie stellt heutzutage eine Standardprozedur dar, die in der Frühphase zur diagnostischen Abklärung einer fehlenden Primärfunktion oder eines Kreatininanstiegs eingesetzt wird. Im weiteren Verlauf dient sie der Abklärung eines akuten oder schleichenden Kreatininanstiegs sowie der Diagnostik einer neu auftretenden Proteinurie oder Erythrozyturie. Weiterhin wichtig ist die Beurteilung der initialen Qualität des Nierentransplantats durch die Pathologie mittels einer intraoperativ gewonnenen Nierenbiopsie (Nullbiopsie). Dies ist angesichts der immer knapper werdenden Spenderorgane und der daraus resultierenden Notwendigkeit, auch grenzwertige Organe unter bestimmten Umständen wie z. B. im Rahmen der so genannten „Old-for-old-Programme“ zu transplantieren, notwendig. Des Weiteren werden heute in vielen Transplantationszentren so genannte Protokollbiopsien durchgeführt, d. h. Biopsien, die nicht akut indiziert sind, aber in einem bestimmten zeitlichen Abstand nach Nierentransplantation durchgeführt werden, um subklinische Abstoßungen sowie frühzeitige Veränderungen, die auf eine chronische Transplantatschädigung hinweisen, zu entdecken. Die Protokollbiopsien dienen außerdem dazu, wissenschaftliche Aspekte der Nierentransplantation systematisch zu untersuchen.
Abstract
Biopsy of the transplanted kidney plays an important role in the care and treatment of patients after kidney transplantation. Today the renal biopsy is a standard procedure which is performed early after renal transplantation in the case of a primary non-functioning graft or a significant rise in serum creatinine. On the other hand, a kidney biopsy is performed if an acute or creeping rise in serum creatinine or acute onset of proteinuria or erythrocyturia is observed during follow-up. Furthermore, zero biopsies or intraoperative biopsies of the graft are important in order to obtain information about the initial quality of the graft. This is particularly important in view of the shortage of donor organs and the resulting necessity to accept increasingly marginal organs, such as for example in the ESP program. In addition, an increasing number of transplant centres perform protocol biopsies, i.e. biopsies that are not based on clinical indication, but are performed at a certain time point after transplantation to detect subclinical rejections as well as histological alterations pointing to chronic allograft damage. Additionally, there is much scientific interest in protocol biopsies.
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Amann, K., Büttner, M., Benz, K. et al. Nierentransplantatpathologie. Pathologe 32, 124–134 (2011). https://doi.org/10.1007/s00292-010-1406-y
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DOI: https://doi.org/10.1007/s00292-010-1406-y