Predicting subsequent decline in kidney allograft function from early surveillance biopsies
Predicting subsequent decline in kidney allograft function from early surveillance biopsies
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DOI：
10.1111/j.1600-6143.2005.01050.x
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发表时间：
2005-10-01
影响因子：
8.8
通讯作者：
Stegall, MD
中科院分区：
文献类型：
--
作者：
Cosio, FG;Grande, JP;Stegall, MD
确定预测移植肾丢失的因素可能是延长移植肾存活的重要一步。在这项研究中，我们试图确定一年监测活检的组织学变化、移植物功能变化和存活率之间的关系。这项分析包括292名成人，他们接受了来自活体捐赠者(69%)或已故捐赠者(31%)的肾脏，他们在1998至2001年间进行了移植，并进行了46个+/-14个月的随访。主要的终点是死亡审查的移植物损失或一年后GFR减少50%。一年的肾活检分为：(I)正常(N=87，30%)，(Ii)炎症(N=6，2%)，(Iii)纤维化(N=131，45%)，(Iv)纤维化和炎症(N=53，18%)和(V)移植肾小球病变(N=15，5%)。多因素COX分析显示，生存与肝活检分型(HR=4.2p=0.001)、移植物功能(HR=0.97p=0.001)和人类白细胞抗原错配(HR=1.003，p=0.004)有关。以正常组织学为参照，纤维化和炎症(HR=8.5p<；0.0001)和肾小球病变(HR=10，p<；0.0001)与较差的存活率相关，但仅有轻度纤维化并不相关。重要的是，与纤维化相关的炎症程度一般不符合诊断临界排斥反应的条件。总之，移植后1年的炎症和肾小球病变独立于功能和其他变量预测移植物功能丧失和移植物衰竭。
Identifying factors that are predictive of allograft loss might be an important step toward prolonging kidney allograft survival. In this study we sought to determine the association between histologic changes on 1-year surveillance biopsies, changes in graft function and survival. This analysis included 292 adults, recipients of kidneys from living donors (69%) or deceased donors (31%), transplanted between 1998 and 2001 and followed up for 46 +/- 14 months. The primary end point was death-censored graft loss or a > 50% reduction in GFR beyond 1 year. One-year biopsies were classified as: (i) Normal (N = 87, 30%), (ii) inflammation (N = 6, 2%), (iii) fibrosis (N = 131, 45%), (iv) fibrosis and inflammation (N = 53, 18%) and (v) transplant glomerulopathy (N = 15, 5%). By multivariate Cox analysis, survival related to biopsy classification (HR = 4.2, p = 0.001), graft function (HR = 0.97, p = 0.001) and HLA mismatches (HR = 1.003, p = 0.004). Using normal histology as a reference, fibrosis and inflammation (HR = 8.5, p < 0.0001) and glomerulopathy (HR = 10, p < 0.0001) related to poorer survival but mild fibrosis alone did not. Importantly, the degree of inflammation associated with fibrosis generally did not qualify for the diagnosis of borderline rejection. In conclusion, inflammation and glomerulopathy 1 year post-transplant predict loss of graft function and graft failure independently of function and other variables.