Reasons for non-use of recovered kidneys: The effect of donor glomerulosclerosis and creatinine clearance on graft survival
Reasons for non-use of recovered kidneys: The effect of donor glomerulosclerosis and creatinine clearance on graft survival
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DOI：
10.1097/01.tp.0000123080.19145.59
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发表时间：
2004-05-15
期刊：
影响因子：
6.2
通讯作者：
Kauffman, HM
中科院分区：
文献类型：
--
作者：
Edwards, EB;Posner, MP;Kauffman, HM
背景2000年，器官共享联合网络/器官获取和移植网络登记处报告说，540个恢复的肾脏因活组织检查结果而被丢弃，210个因器官功能不佳而被丢弃。我们比较了丢弃和移植的尸体肾的肾小球硬化（GS）和肌酐清除率（CrCl）的百分比，并检查它们对移植物存活和功能的影响。该队列包括1999年10月25日至2001年12月31日期间报告活检结果的所有尸体肾脏（n= 3，444）。通过单变量和多变量模型计算移植物存活率。51%的丢弃肾脏的GS小于20%，27%的CrCl大于80 mL/min，和15%（129个肾脏）的GS均小于20%，CrCl大于80 ml/min。GS小于或等于20%的肾脏的单变量分析显示，当CrCl大于或小于或等于80 ml/min时，移植物存活年。当GS大于20%，CrCl大于80 mL/min的肾脏的1年移植物存活率多变量结果显示GS大于20%与小于等于20%的移植物丢失的相对风险无显著差异当CrCl为50或80 mL/min时，GS均小于或等于20%和大于20%时，CrCl大于80 mL/min的肾脏1年时的血清肌酐显著降低。计算的供体CrCl和供体肾活检的GS百分比与1年移植物存活率和功能没有很好的相关性，GS百分比不应作为丢弃恢复的尸体肾的唯一标准。
Background. In 2000, the United Network for Organ Sharing/Organ Procurement and Transplantation Network Registry reported 540 recovered kidneys were discarded because of biopsy results, and 210 were discarded because of poor organ function. We compared the percentage of glomerulosclerosis (GS) and creatinine clearance (CrCl) of both discarded and transplanted cadaveric kidneys and examined their effect on graft survival and function.Methods. The cohort consisted of all cadaveric kidneys (n=3,444) with reported biopsy results between October 25, 1999 and December 31, 2001. Graft survival was calculated by univariate and multivariate models.Results. Fifty-one percent of discarded kidneys had GS of less than 20%, 27% had a CrCl greater than 80 mL/min, and 15% (129 kidneys) had both GS less than 20% and a CrCl of greater than 80 ml/min. Univariate analyses of kidneys with less than or equal to 20% GS revealed no difference in 1-year graft survival when the CrCl was greater than or less than or equal to 80 ml/min. When GS was greater than 20%, 1-year graft survival of kidneys with a CrCl of greater than 80 mL/min was significantly greater than that of kidneys with a CrCl of less than or equal to 80 mL/min. Multivariate results showed no significant difference in relative risk of graft loss with GS greater than 20% versus less than or equal to 20% when the CrCl was either 50 or 80 mL/min. With both GS less than or equal to 20% and greater than 20%, serum creatinine at 1 year was significantly lower in kidneys with CrCl greater 80 mL/min.Conclusions. Calculated donor CrCl does, and percentage GS on donor kidney biopsies does not, correlate well with 1-year graft survival and function, and percentage GS should not be used as the sole criterion for discarding recovered cadaveric kidneys.