Pre-Implant Biopsy Predicts Outcome of Single-Kidney Transplantation Independent of Clinical Donor Variables
Pre-Implant Biopsy Predicts Outcome of Single-Kidney Transplantation Independent of Clinical Donor Variables
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DOI：
10.1097/01.tp.0000437428.12356.4a
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发表时间：
2014-02-27
期刊：
影响因子：
6.2
通讯作者：
Kletzmayr, Josef
中科院分区：
文献类型：
--
作者：
Hofer, Johannes;Regele, Heinz;Kletzmayr, Josef
背景植入前活检发现是许多供体肾脏被丢弃的原因，尽管其临床价值尚不完全清楚。我们回顾研究了植入前组织学对单肾移植后长期同种异体肾移植和受者预后的预测价值，在我们中心，这些组织学是出于协议目的，而不是为了移植决策。方法这项单中心研究包括628例连续的成年受者174个扩大标准供体(ECD)和454个标准供体肾脏。根据肾小球、血管、肾小管和间质损害的整合，应用慢性损害评分来评估慢性供体器官损伤，以区分轻度、中度和严重的组织学器官损伤。结果慢性轻、中度病变的供肾移植和移植肾存活率基本相同，分别为1.20，95%可信区间0.83~1.74，P=0.326和1.27，95%可信区间0.83~1.95，P=0.274。然而，如果移植肾损伤严重，发生在3%的移植肾中，移植物和受者的存活率显著降低(HR 3.13，95%CI 1.61-6.07，P
Background Pre-implant biopsy findings account for the discard of many donor kidneys although their clinical value is not fully understood. We retrospectively investigated the predictive value of pre-implant histology, which in our center was obtained for protocol purposes, not for transplant decisions, on long-term allograft and recipient outcome after single-kidney transplantation.Methods This single-center study included 628 consecutive adult recipients of 174 Expanded Criteria Donor (ECD) and 454 Standard Criteria Donor kidneys. Chronic donor organ injury was assessed applying a chronic lesion score differentiating between mild, moderate, and severe histologic organ injury based on the integration of glomerular, vascular, tubular, and interstitial lesions. Recipients were followed over a median time of 7.8 years.Results Donor kidneys exhibiting mild or moderate chronic lesions yielded almost identical graft and recipient survival independent of ECD status or other clinical covariables (HR 1.20, 95% CI 0.83-1.74, P=0.326, and HR 1.27, 95% CI 0.83-1.95, P=0.274, respectively). However, if allograft injury was severe, occurring in 3% of transplanted kidneys, graft and recipient survival was significantly reduced (HR 3.13, 95% CI 1.61-6.07, P