The Impact of Time-Zero Biopsy on Early Graft Outcomes After Living Donor Kidney Transplantation
The Impact of Time-Zero Biopsy on Early Graft Outcomes After Living Donor Kidney Transplantation
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DOI：
10.1016/j.transproceed.2013.08.081
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发表时间：
2013-10-01
影响因子：
0.9
通讯作者：
Huh, K. H.
中科院分区：
文献类型：
--
作者：
Lee, A. L.;Kim, Y. S.;Huh, K. H.
背景与死亡供体移植相比，活体肾移植后零时活检病理学结果的临床意义很少报道，因为预期组织学结果和肾功能正常。本研究的目的是确定活体供者的亚临床病理学表现，并检查对早期移植肾功能的影响。在2006年12月至2011年7月期间，146名活体供肾移植受者入选本研究。我们回顾性分析了供者和受者相关的临床参数，并在移植后6个月和1年估计肾小球滤过率（eGFR）作为早期移植肾功能。采用2007年Banff标准对零时活检进行评价。根据Banff评分，大多数异常组织学结果为轻度。0时活检病理结果为肾小球硬化（GS，35.6%）、肾小管萎缩（CT，36.3%）、间质纤维化（CI，20.5%）、血管纤维内膜增厚（CV，4.1%）、小动脉透明样增厚（AR，14.4%）、间质炎症（I，3.4%）。单变量分析显示，供体年龄和性别与移植后6个月和1年的eGFR显著相关（P <0.05）。此外，GS和CT与早期移植肾功能显著相关（P <0.05）。然而，多元线性回归分析显示，只有供体年龄与早期移植肾功能显著相关（P = 0.001）。在活体供肾移植中，零时活检的轻度亚临床病理结果不影响早期移植肾功能。
Background. In contrast with deceased donor transplantation, the clinical significance of pathologic findings in time-zero biopsies after living donor kidney transplantation are rarely reported, due to the expectation that histologic findings and renal function are normal. The aim of this study was to identify subclinical pathologic findings in living donors and examine the effect on early graft renal function.Methods. Between December 2006 and July 2011, 146 living-donor kidney transplant recipients were enrolled in this study. We retrospectively analyzed donor and recipient-related clinical parameters, and post-transplant 6 months and 1 year estimated glomerular filtration rate (eGFR) as early graft renal function. Time-zero biopsies were evaluated using the 2007 Banff criteria.Results. Most abnormal histologic findings were of mild degree as determined by Banff scores. Global glomerulosclerosis (GS, 35.6%), tubular atrophy (CT, 36.3%), interstitial fibrosis (CI, 20.5%), vascular fibrous intimal thickening (CV, 4.1%), arteriolar hyaline thickening (AR, 14.4%), interstitial inflammation (I, 3.4%) were pathologic findings in time-zero biopsies. The univariate analysis revealed that donor age and gender were significantly associated with eGFR at post-transplant 6 months and at 1 year (P < .05). Furthermore, GS and CT were significantly associated with early graft renal function (P < .05). However, multivariate linear regression analysis showed only donor age was significantly associated with early graft renal function (P = .001).Conclusion. A mild degree of subclinical, pathologic findings on time-zero biopsy did not affect early graft renal function in living-donor kidney transplantation.