Vallejos Augusto, Alperovich Gabriela, Moreso Francesc, Cañas Concepcion, de Lama M Eugenia, Gomà Montserrat, Fulladosa Xavier, Carrera Marta, Hueso Miguel, Grinyó Josep M, Serón Daniel
Department of Nephrology, Hospital Universitari Bellvitge, C/Feixa Llarga s/n, L'Hospitalet, 08907 Barcelona, Spain.
Nephrol Dial Transplant. 2005 Nov;20(11):2511-6. doi: 10.1093/ndt/gfi041. Epub 2005 Aug 2.
The presence of chronic allograft nephropathy (CAN) in protocol biopsies is negatively associated with graft survival. Although recent studies have indicated that the resistive index (RI) is a predictor of graft failure, it does not correlate with CAN in stable grafts. We therefore studied the relationship between RI and CAN and examined the predictive value of both parameters on graft outcome.
Included were patients transplanted between 1997 and 2002 and who had protocol biopsies and RI determinations. Renal lesions were blindly evaluated according to Banff 97 criteria. Mean glomerular volume, cortical interstitial volume fraction and intimal arterial volume fraction were estimated using a point counting technique. RI was determined before biopsy in at least two different renal locations. The outcome variable was defined as graft failure or a 30% serum creatinine increase between protocol biopsy and last follow-up.
Eighty-seven patients were included. RI correlated with recipient age (R = 0.52, P < 0.0001), diastolic blood pressure (R = -0.36, P = 0.0006), pulse pressure index (R = 0.27, P = 0.009) and g-score for histological glomerulitis (rho = 0.30, P = 0.0054), but there were no correlations between RI and chronic Banff scores or any morphometric parameter. The presence of CAN (relative risk, 3.5; 95% confidence interval 1.2-10.2; P = 0.02) but not RI was associated with the outcome variable.
RI was associated with surrogate measures of vascular compliance such as recipient age and pulse pressure index but not with chronic allograft damage, even when it was evaluated by histomorphometry. Our results indicate that histology may be superior to RI in predicting graft function deterioration, at least in patients with stable renal function.
在方案活检中慢性移植肾肾病（CAN）的存在与移植肾存活呈负相关。尽管最近的研究表明阻力指数（RI）是移植肾失败的一个预测指标，但在稳定的移植肾中它与CAN并无关联。因此，我们研究了RI与CAN之间的关系，并检验了这两个参数对移植肾结局的预测价值。
纳入1997年至2002年间接受移植且进行了方案活检和RI测定的患者。根据Banff 97标准对肾脏病变进行盲法评估。使用点计数技术估算平均肾小球体积、皮质间质体积分数和内膜动脉体积分数。在活检前至少在两个不同的肾脏部位测定RI。结局变量定义为移植肾失败或在方案活检至最后一次随访期间血清肌酐升高30%。
纳入87例患者。RI与受者年龄（R = 0.52，P < 0.0001）、舒张压（R = -0.36，P = 0.0006）、脉压指数（R = 0.27，P = 0.009）以及组织学肾小球炎的g评分（rho = 0.30，P = 0.0054）相关，但RI与慢性Banff评分或任何形态学参数之间无相关性。CAN的存在（相对风险，3.5；95%置信区间1.2 - 10.2；P = 0.02）而非RI与结局变量相关。
RI与血管顺应性的替代指标如受者年龄和脉压指数相关，但与慢性移植肾损伤无关，即使通过组织形态计量学进行评估也是如此。我们的结果表明，至少在肾功能稳定的患者中，组织学在预测移植肾功能恶化方面可能优于RI。
