Randhawa P S, Minervini M I, Lombardero M, Duquesnoy R, Fung J, Shapiro R, Jordan M, Vivas C, Scantlebury V, Demetris A
Division of Transplantation Pathology, University of Pittsburgh Medical Center and University of Pittsburgh, Pennsylvania, USA.
Transplantation. 2000 Apr 15;69(7):1352-7. doi: 10.1097/00007890-200004150-00024.
Kidney biopsies are being used to evaluate marginal donors, but rigorous statistical validation of this practice with multivariate analysis has not been performed.
To analyze histologic parameters in 78 donor biopsies for their ability to predict graft dysfunction, we used a proportional odds model that included both donor and recipient factors. Glomerulosclerosis was categorized into grades 0, 1, 2, and 3, corresponding to 0, 1-10%, 11-20%, and 21-30% global sclerosis, respectively. The degrees of interstitial fibrosis, tubular atrophy, arteriosclerosis, and arteriolar hyalinosis were graded from 0 to 3+, using definitions suggested by the Banff Schema of allograft pathology.
Increasing donor age was associated with higher glomerulosclerosis, tubular atrophy, and arteriosclerosis. Kidneys with any degree of interstitial fibrosis were 2.6 times [odds ratio (OR)] more likely to experience a worse outcome at 6 months (P = 0.02). This association held up after correction for acute rejection (OR 2.5, P = 0.03) and high panel-reactive antibody (OR 3.4, P = 0.006), However, the OR was reduced to 1.9 (P = 0.15) after controlling for recipient age. With each increment in the grade of glomerulosclerosis, the odds for a worse outcome at 12 months increased to 2.3 (P = 0.005). The value for OR became 2.0 (P = 0.03) when controlling for recipient age (P = 0.01), 2.4 (P = 0.005), when controlling for acute rejection, and 2.3 (P = 0.006) when controlling for high panel-reactive antibody.
Histopathological parameters present in donor biopsies can independently predict post-transplant graft function. Implications for the pool of donor organs available for transplantation are discussed.
肾活检正被用于评估边缘供体，但尚未通过多变量分析对这种做法进行严格的统计学验证。
为分析78例供体活检组织的组织学参数预测移植肾功能障碍的能力，我们使用了一个包含供体和受体因素的比例优势模型。肾小球硬化分为0、1、2和3级，分别对应0、1 - 10%、11 - 20%和21 - 30%的全球硬化。使用移植病理Banff标准建议的定义，将间质纤维化、肾小管萎缩、动脉硬化和小动脉玻璃样变的程度从0分级到3 +。
供体年龄增加与更高程度的肾小球硬化、肾小管萎缩和动脉硬化相关。有任何程度间质纤维化的肾脏在6个月时出现更差结局的可能性是其2.6倍[优势比（OR）]（P = 0.02）。在校正急性排斥反应（OR 2.5，P = 0.03）和高群体反应性抗体（OR 3.4，P = 0.006）后，这种关联仍然成立。然而，在控制受体年龄后，OR降至1.9（P = 0.15）。随着肾小球硬化分级的每一次增加，12个月时出现更差结局的几率增加到2.3（P = 0.005）。在控制受体年龄时（P = 0.01），OR值变为2.0（P = 0.03）；在控制急性排斥反应时，OR值为2.4（P = 0.005）；在控制高群体反应性抗体时，OR值为2.3（P = 0.006）。
供体活检组织中的组织病理学参数可独立预测移植后肾功能。讨论了对可用于移植的供体器官库的影响。
