Histological assessment of preimplantation biopsies may improve selection of kidneys from old donors after cardiac death
Histological assessment of preimplantation biopsies may improve selection of kidneys from old donors after cardiac death
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DOI：
10.1111/j.1600-6143.2008.02318.x
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发表时间：
2008-09-01
影响因子：
8.8
通讯作者：
van Heurn, L. W. E.
中科院分区：
文献类型：
--
作者：
Snoeijs, M. G. J.;Buurman, W. A.;van Heurn, L. W. E.
心脏性死亡（DCD）后的老年供肾可增加供肾来源，但其预后并不理想。为了改善这些结果，我们回顾性评估了已发表的老年供体肾选择算法的诊断效用。我们研究了1994年1月1日至2005年7月1日在我们机构进行的所有DCD肾移植（n = 199）。在60岁或60岁以上供体的肾移植子集中评价选择算法（n = 52）。对于肾活检的组织学评估，对肾小球硬化、肾小管萎缩、间质纤维化和血管狭窄进行盲法评分。功能性肾重量计算为肾质量乘以非硬化肾小球分数。年龄≥ 60岁的DCD移植肾功能和存活率均低于年轻DCD。组织学评分与陈旧性DCD肾移植的肾功能和移植物存活率相关。功能性肾重量与肾功能相关，但与移植物存活率无关，而供体肾小球滤过率（GFR）、供体年龄和机器灌注特征与临床结果无关。我们的结论是，植入前活检的组织学评估可能会改善从旧DCD的肾脏的选择，因此可能有助于扩大供体库。
Kidneys from old donors after cardiac death (DCD) may increase the donor pool but the prognosis of these kidneys is unsatisfactory. To improve these results, we retrospectively evaluated the diagnostic utility of published selection algorithms for old donor kidneys. We studied all DCD kidney transplantations between January 1, 1994 and July 1, 2005 at our institution (n = 199). Selection algorithms were evaluated in the subset of kidney transplantations from donors aged 60 years or older (n = 52). For histological assessment of kidney biopsies, glomerulosclerosis, tubular atrophy, interstitial fibrosis and vascular narrowing were blindly scored. Functional kidney weight was calculated as renal mass multiplied by the fraction of nonsclerosed glomeruli. Graft function and survival of kidneys from DCD aged 60 years or older were inferior to those from younger DCD. Histological scores were associated with kidney function and graft survival of old DCD kidney transplantations. Functional kidney weight was associated with kidney function but not graft survival, while donor glomerular filtration rate (GFR), donor age and machine perfusion characteristics were associated with neither of the clinical outcomes of interest. We conclude that histological assessment of preimplantation biopsies may improve the selection of kidneys from old DCD and may therefore contribute to expansion of the donor pool.