Howie Alexander J, Ferreira Maria Alice S, Lipkin Graham W, Adu Dwomoa
Department of Pathology, University of Birmingham, Birmingham, United Kingdom.
Transplantation. 2004 Apr 15;77(7):1058-65. doi: 10.1097/01.tp.0000120177.44144ff.
So-called marginal kidneys are used increasingly in renal transplantation, but features of marginal kidneys are disputed.
To help define marginal, a morphometric measure, the index of chronic damage, was applied retrospectively to 500 implantation biopsy specimens of cadaveric grafts, and death-censored graft survival was calculated, up to 14 years after transplantation.
An index of 0% (n=242) was associated with better survival than 1%, with little difference between 1% and 39% (n=249). An index of 40% or more (n=9) was associated with the worst survival (chi=14.2, 2 df, P <0.001). After controlling for donor age, the only values of the index related to survival were 40% and above (hazard ratio, 2.96; P =0.01). Donor age group 10 to 39 years old (n=238) had better survival than 1 to 9 years old (n=26) and 40 to 73 years old (n=236) (hazard ratios, 2.83 and 2.06, respectively; P <0.001). An early episode of acute rejection affected survival even at 6 years and later after transplantation (hazard ratio, 1.94; P <0.04).
Marginal kidneys are identified using the index of chronic damage, but they are so rare that measurement is not necessary on every graft. After routine graft allocation and in the absence of acute rejection, a kidney from virtually any donor in an age group has the same potential as a graft from nearly all others in that group.
所谓的边缘性肾脏在肾移植中的应用越来越多，但边缘性肾脏的特征存在争议。
为了帮助定义边缘性，一种形态学测量方法，即慢性损伤指数，被回顾性应用于500例尸体肾移植植入活检标本，并计算移植后长达14年的死亡截尾肾存活率。
0%（n = 242）的指数与比1%更好的存活率相关，1%和39%（n = 249）之间差异不大。40%或更高（n = 9）的指数与最差的存活率相关（χ² = 14.2，2 df，P < 0.001）。在控制供体年龄后，与存活率相关的指数值仅为40%及以上（风险比，2.96；P = 0.01）。10至39岁的供体年龄组（n = 238）的存活率优于1至9岁（n = 26）和40至73岁（n = 236）（风险比分别为2.83和2.06；P < 0.001）。移植后6年及以后，急性排斥反应的早期发作仍会影响存活率（风险比，1.94；P < 0.04）。
使用慢性损伤指数可识别边缘性肾脏，但它们非常罕见，因此不必对每个移植物进行测量。在常规移植物分配后，且无急性排斥反应时，几乎任何年龄组供体的肾脏与该组几乎所有其他供体的移植物具有相同的潜力。
