Significance of Preimplantation Analysis of Kidney Biopsies From Expanded Criteria Donors in Long-Term Outcome
Significance of Preimplantation Analysis of Kidney Biopsies From Expanded Criteria Donors in Long-Term Outcome
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DOI：
10.1097/tp.0b013e318204bdd7
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发表时间：
2011-02-27
期刊：
影响因子：
6.2
通讯作者：
Aljama Garcia, Pedro
中科院分区：
文献类型：
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作者：
Dolores Navarro, Maria;Lopez-Andreu, Maria;Aljama Garcia, Pedro
背景。器官短缺导致捐献者的标准不断扩大。移植前的组织学评估可以识别不适合单次植入的器官。本研究的目的是评估组织学结果作为扩展标准供体（ECD）同种异体移植物存活的预后因素。方法。我们纳入了 136 例单次 ECD 肾脏移植队列，并将植入前病理结果与移植失败相关联。对年龄大于 60 岁 (n = 104) 或小于 (n = 32) 的 ECD 肾脏结构进行组织学评估以了解肾脏衰老情况，并根据总组织学评分进行评分。进行多变量 Cox 分析以确定移植失败的预测因子。结果。肾小球硬化症是 60 岁以下供体活检中最常见的病变（P = 0.002）；老年捐献者的活检中间质纤维化更为严重（P = 0.001）；老年供者肾小管萎缩的发生率较高（P = 0.022），而血管室显示无显着差异。基于肾活检的评分系统范围为 0 至 15 分，表明肾实质存在变化。总组织学评分小于或等于 5 的活检显示，与评分大于 5 的活检相比，5 年移植物存活率显着提高 (P
Background. The shortage of organs has led to expanding the criteria for donors. Histologic evaluations before transplantation may enable the identification of organs unsuitable for single implantation. The aim of this study was to evaluate the histologic findings as prognostic factors of allograft survival from expanded criteria donors (ECDs).Methods. We included a cohort of 136 single transplantations with kidneys from ECD and correlated the preimplantation pathologic findings with graft failure. Renal structures from ECD older (n = 104) or younger (n = 32) than 60 years were evaluated histologically for renal senescence and rated with a total histologic score. A multivariate Cox analysis was performed to identify predictors of graft failure.Results. Glomerulosclerosis was the most prevalent lesion in biopsies from donors older and younger than 60 years (P = 0.002); interstitial fibrosis was more severe in biopsies from older donors (P = 0.001); older donors showed a higher prevalence of tubular atrophy (P = 0.022), and vascular compartment showed no significant differences. Kidney biopsy-based scoring system ranged from 0 to 15 points, indicating the presence of changes in the renal parenchyma. Biopsies with total histologic scores less than or equal to 5 showed significantly better 5-year graft survival than those with scores more than 5 (P