Correlation of Glomerular Size With Donor-Recipient Factors and With Response to Injury.
Correlation of Glomerular Size With Donor-Recipient Factors and With Response to Injury.
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DOI：
10.1097/tp.0000000000003570
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发表时间：
2021-11-01
期刊：
影响因子：
6.2
通讯作者：
Matas AJ
中科院分区：
文献类型：
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作者：
Grande JP;Helgeson ES;Matas AJ
同种异体肾移植的肾小球大小受供体-受体因素和损伤反应的影响。在功能良好的移植物患者的连续活检中，肾小球大小的增加与更好的生存率相关。然而，之前没有研究涉及肾小球大小在因故活检时与损伤的临床/组织病理学标志物的关系，或对长期移植结果的影响。研究人员对参与同种异体肾移植功能恶化（DeKAF）研究的两组肾移植受者进行了评估：前瞻性队列（PC, n=581）：移植后1.7±1.4年（平均±SD）接受首次病因肾活检（KTxBx）的患者；横断面队列（CSC, n=446）：移植后7.7±5.6年出现新发肾功能恶化的患者。测量所有含血管极的肾小球的平面表面积和直径。根据Banff标准，以盲法集中读取KTxBx。CSC的肾小球面积明显高于PC；在两个队列中，从移植到指征活检的时间与肾小球面积相关（p值≤0.001）。肾小球面积与微血管炎症（肾小球炎、小管周围毛细血管浸润，p值≤0.001）和节段性肾小球硬化相关（p值<0.0001）。在CSC中，考虑微血管炎症后，较高的肾小球面积与较高的eGFR （p值≤0.001）和移植物存活率增加相关（校正风险比=0.967;95% CI: 0.948 ~ 0.986；无糖尿病或AMR证据的活检风险比=0.919,95% CI: 0.856 ~ 0.987）。肾小球大小与指征活检时的组织病理学特征和移植物在CSC中的存活率增加有关。
Glomerular size in renal allografts is impacted by donor-recipient factors and response to injury. In serial biopsies of patients with well-functioning grafts, increased glomerular size correlates with better survival. However, no previous study has addressed association of glomerular size at the time of a for-cause biopsy and clinical/histopathologic markers of injury, or effect on long term graft outcome. Two cohorts of kidney transplant recipients enrolled in the Deterioration of Kidney Allograft Function (DeKAF) study were evaluated: The Prospective Cohort (PC, n=581): Patients undergoing first for cause kidney biopsy (KTxBx) 1.7±1.4 (mean ±SD) years posttransplant; and the Cross sectional Cohort (CSC, n=446): patients developing new-onset renal function deterioration 7.7 ± 5.6 years posttransplant . Glomerular planar surface area and diameter were measured on all glomeruli containing a vascular pole. KTxBx were read centrally in a blinded fashion according to Banff criteria. Glomerular area was significantly higher in the CSC than the PC; time from transplant to indication biopsy was associated with glomerular area in both cohorts (p-values ≤0.001). Glomerular area was associated with indices of microvascular inflammation (glomerulitis, peritubular capillary infiltrates; p-values ≤0.001) and segmental glomerulosclerosis (p-value <0.0001). In the CSC, higher glomerular area was associated with higher eGFR (p-value≤0.001) and increased graft survival after accounting for microvascular inflammation (adjusted hazard ratio =0.967; 95% CI: 0.948 to 0.986; hazard ratio in biopsies without evidence of diabetes or AMR=0.919, 95% CI: 0.856 to 0.987). Glomerular size is associated with histopathologic features present at the time of indication biopsy and with increased graft survival in the CSC.