Browsing by Author "Figueiredo, AJ"
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- Histological alterations found in the ureter during organ preservation and early phases of renal transplantationPublication . Figueiredo, AJ; Cunha, MX; Mota, A; Furtado, ALINTRODUCTION: There are no studies on the phenomena that occur on the ureter during organ preservation and immediately after transplantation. MATERIAL AND METHODS: We studied ureteral fragments obtained during organ harvesting in the cadaver (n = 9), after cold preservation period (n = 18), and immediately after kidney graft reperfusion (n = 126). In addition to the histological analysis, we evaluated the risk factors for the development of lesions and their relation to the evolution of the transplant. RESULTS: Alterations were detected in 120 of the 126 fragments studied after graft reperfusion. Global cellular infiltration was considered to be normal, mild, and moderate to severe in 34.9%, 41.3%, and 23.8%, respectively, consisting mainly of CD8(+) T lymphocytes. Urothelial exfoliation and cell vacuolization were detected in 42% and 52.4% of the cases, respectively. There was an inverse relationship between donor ventilation time and the intensity of the cellular infiltration. Seven and three of the nine fragments obtained during organ harvesting showed mild cellular infiltration of the chorion and urothelium, respectively. Cold storage promoted minor histological changes. After reperfusion, there was increased urothelial infiltration in 11 of the 18 cases. There was no relation between the lesions encountered and human leukocyte antigen compatibilities, renal rejections episodes, or the evolution of the graft itself. CONCLUSIONS: Consequences of brain death mechanical ventilation were detected at the ureteral level, with abnormal lymphocytic infiltration in most cases. Cold storage did not produce any major histological changes. The lesions detected after graft reperfusion do not seem to involve immunological phenomena.
- Ureteric lesions detected in normally functioning kidney allografts: risk factors and clinical implicationsPublication . Figueiredo, AJ; Cunha, MX; Mota, A; Furtado, ALINTRODUCTION: We characterized the alterations in ureteral biopsies from normally functioning kidney allografts to study risk factors. MATERIALS AND METHODS: We studied 55 ureteral fragments from kidney grafts obtained during cystoscopy for routine double-J stent extraction. We evaluated the type and severity of the lesions, the risk factors for their occurrence, and their relation to the evolution of the transplant, including the occurrence of renal rejection episodes or ureteral complications. RESULTS: Borderline or rejection lesions were detected in 21 of the 55 fragments. Rejection lesions were more common among biopsies performed in the first 80 days (54.6%) than during the 120 days afterward (15.4%, P = .043). Similarly, urothelium reactivity was detected in 71.4% and 30.7% of the biopsies performed up to and after 4 months, respectively (P = .008). Urothelial atrophy was detected in 20% of the fragments, the age of the donors being higher in these cases (P = .026). There was a trend to the association of borderline or rejection lesions in the ureteral biopsies and a history of an acute renal rejection episode (P = .053). There were no detectable relations between those findings and the evolution of the transplant. CONCLUSIONS: Thirty-eight percent of the biopsed ureters showed rejection or borderline lesions, these lesions were more common among biopsies done in the first months after transplantation. These findings are similar to the ones found in routine renal biopsies. We did not find any significant relation between the nature of the lesions encountered on the ureteral biopsies and the evolution of the transplant.