Abnormal time-zero histology is predictive of kidney transplant outcomes.
Abnormal time-zero histology is predictive of kidney transplant outcomes.
复制标题
异常的零时组织学可以预测肾移植的结果。
DOI：
10.1111/ctr.14676
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发表时间：
2022-07
影响因子：
2.1
通讯作者：
中科院分区：
文献类型：
--
作者：
零时活检可以在肾移植时检测到供体来源的病变，但在更新的肾脏分配系统下，其在预测长期结局方面的效用尚不清楚。我们对272例连续再灌注后零时活检进行了单中心回顾性队列研究。我们检验了这样一个假设，即异常的零时组织学是供体质量的一个强有力的指标，可以提高肾脏供体特征指数（KDPI）评分的精度，以预测长期结局。我们在42%的队列中检测到异常活检，在调整包括KDPI在内的临床特征后，这些异常活检与急性排斥反应、同种异体移植失败和死亡的复合风险增加1.2倍独立相关。通过Kaplan-Meier分析，零时异常组织学与复合终点之间的关系仅在KDPI评分> 35的死亡供体肾移植亚组中具有显著性。异常零时组织学，特别是血管内膜纤维化和小动脉玻璃样变性评分，与12个月估计GFR降低独立相关。总之，异常的零时组织学是相对常见的，并确定了一组肾移植受者的风险增加，为更糟糕的长期结果。需要进一步的研究来确定最佳的患者人群，在其中部署零时活检作为额外的监测工具。
Time-zero biopsies can detect donor-derived lesions at the time of kidney transplantation, but their utility in predicting long-term outcomes is unclear under the updated Kidney Allocation System. We conducted a single-center retrospective cohort study of 272 consecutive post-reperfusion time-zero biopsies. We tested the hypothesis that abnormal time-zero histology is a strong indicator of donor quality that increases the precision of the kidney donor profile index (KDPI) score to predict long-term outcomes. We detected abnormal biopsies in 42% of the cohort, which were independently associated with a 1.2-fold increased hazard for a composite of acute rejection, allograft failure, and death after adjusting for clinical characteristics including KDPI. By Kaplan-Meier analysis, the relationship between abnormal time-zero histology and the composite endpoint was only significant in the subgroup of deceased donor kidney transplants with KDPI scores > 35. Abnormal time-zero histology, particularly vascular intimal fibrosis and arteriolar hyalinosis scores, was independently associated with lower 12-month estimated GFR. In conclusion, abnormal time-zero histology is relatively common and identifies a group of kidney recipients at increased risk for worse long-term outcomes. Further studies are needed to determine the optimal patient population in which to deploy time-zero biopsies as an additional surveillance tool.
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影响因子：
6.2
作者：
Edwards, EB;Posner, MP;Kauffman, HM
通讯作者：
Kauffman, HM
影响因子：
6.2
作者：
Nankivell, BJ;Fenton-Lee, CA;Chapman, JR
通讯作者：
Chapman, JR
影响因子：
0.9
作者：
Lee, A. L.;Kim, Y. S.;Huh, K. H.
通讯作者：
Huh, K. H.
DOI：
10.1111/ajt.12928
发表时间：
2014-11
期刊：
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
影响因子：
--
作者：
Gandolfini I;Buzio C;Zanelli P;Palmisano A;Cremaschi E;Vaglio A;Piotti G;Melfa L;La Manna G;Feliciangeli G;Cappuccilli M;Scolari MP;Capelli I;Panicali L;Baraldi O;Stefoni S;Buscaroli A;Ridolfi L;D'Errico A;Cappelli G;Bonucchi D;Rubbiani E;Albertazzi A;Mehrotra A;Cravedi P;Maggiore U
通讯作者：
Maggiore U
影响因子：
8.8
作者：
Lodhi, S. A.;Lamb, K. E.;Meier-Kriesche, H. U.
通讯作者：
Meier-Kriesche, H. U.