Glomerular Function, Structure, and Number in Renal Allografts from Older Deceased Donors
Glomerular Function, Structure, and Number in Renal Allografts from Older Deceased Donors
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DOI：
10.1681/asn.2008030306
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发表时间：
2009-01-01
影响因子：
13.6
通讯作者：
Myers, Bryan D.
中科院分区：
文献类型：
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作者：
Tan, Jane C.;Workeneh, Biruh;Myers, Bryan D.
高龄死者供者移植肾的5年存活率明显低于年轻死者供者。为了评价肾脏衰老在移植物存活缩短中的潜在作用，分析了年龄大于55岁（“老化”）或年龄小于40岁（“年轻”）的已故供体的同种异体移植物的肾小球功能和结构。老年人肾小球硬化的发生率显著增高（P < 0.002），非硬化性肾小球趋向于更大，滤过表面积更大（P = 0.02），单肾单位超滤系数更高（K（f）; P = 0.07），提示对肾小球功能丧失的代偿反应。在移植受者血清肌酐达到稳定的最低点后，评估GFR及其血流动力学决定因素，并计算整个同种异体移植物K。与来自年轻供体的同种异体移植物相比，来自老年供体的同种异体移植物表现出32%的GFR降低，这完全归因于同种异体移植物K（f）降低45%（均P < 0.001）。此外，老年供体的移植物中每个同种异体移植物的功能性肾小球数量显著低于年轻供体（3.6 +/- 2.1 × 10（5）vs 8.5 +/- 3.4 × 10（5）; P < 0.01），这不能用老年组中相对温和的17%的全球肾小球硬化症患病率来解释。许多老年供体肾小球总数的显著减少可能导致“残肾”现象，这可能解释了这些同种异体移植物平均存活时间较短的原因。
The 5-yr survival rate of renal allografts is significantly lower for grafts from older deceased donors than from younger deceased donors. For evaluation of the potential contribution of renal senescence in this shortened graft survival, glomerular function and structure were analyzed in allografts from deceased donors older than 55 yr ("aging") or younger than 40 yr ("youthful"). Aging donors had a significantly higher prevalence of sclerotic glomeruli (P < 0.002), and their nonsclerotic glomeruli tended to be larger, had a larger filtration surface area (P = 0.02), and had a higher single-nephron ultrafiltration coefficient (K(f); P = 0.07), suggesting a compensatory response to functional loss of glomeruli. After serum creatinine reached a stable nadir in the transplant recipients, GFR and its hemodynamic determinants were evaluated and the whole allograft K, was computed. Compared with the allografts from youthful donors, allografts from aging donors exhibited a 32% lower GFR, which was exclusively attributable to a 45% reduction in allograft K(f) (both P < 0.001). In addition, the number of functioning glomeruli per allograft was profoundly lower in grafts from aging donors than from youthful donors (3.6 +/- 2.1 x 10(5) versus 8.5 +/- 3.4 x 10(5); P < 0.01), and this could not be explained by the relatively modest 17% prevalence of global glomerulosclerosis in the aging group. The marked reduction in overall glomerular number in many aging donors may lead to a "remnant kidney" phenomenon, potentially explaining the shorter mean survival of these allografts.