Arias L F, Blanco J, Sanchez-Fructuoso A, Prats D, Duque E, Sáiz-Pardo M, Ruiz J, Barrientos A
Department of Pathology, University of Antioguia, Carrera SID No. 62-29, Medellin, Antiquia, Colombia.
Transplant Proc. 2007 Jun;39(5):1368-70. doi: 10.1016/j.transproceed.2007.01.085.
We performed a multivariate analysis to evaluate the importance of histologic parameters in donor kidney biopsies as predictors of graft outcome.
Wedge protocol biopsies from a single center were analyzed for glomerulosclerosis (GS), interstitial fibrosis (IF), tubular atrophy (TA), arteriosclerosis (AS), and arteriolar hyalinosis (AH). Alterations were quantified as percentage (GS, IF) or semiquantified according to Banff criteria (IF, TA, AS, AH). We calculated creatinine clearance (CrCl) at 1, 2, and 3 years posttransplant. Donor data included age, gender, and type: non-heart-beating donor or brain dead donors. Recipient data included age, gender, cold ischemia time, number of HLA mismatches, peak level of the panel reactive antibody (PRA), number of acute rejection episodes (ARE), and presence or absence of cytomegalovirus (CMV) disease. Univariate and multivariate analyses were performed. Follow-up range was 1 to 4.2 years.
GS, IF, TA, and AH were associated with graft survival in the multivariate analysis. The histologic parameters were associated with CrCl at several posttransplant time intervals, but the significance of association was lost in the multivariate analysis. Donor age showed a better correlation with graft function. In the univariate analyses adjusting for donor age, only IF and AH were associated with graft function.
Histologic parameters showed a modest association with graft function. In our study, donor age is the better predictor of graft function. IF and AH may be similar to or better than GS as predictors of graft outcome.
我们进行了多变量分析，以评估供体肾活检组织学参数作为移植肾结局预测指标的重要性。
对来自单一中心的楔形活检标本进行分析，观察肾小球硬化（GS）、间质纤维化（IF）、肾小管萎缩（TA）、动脉硬化（AS）和小动脉玻璃样变（AH）情况。病变程度以百分比形式量化（GS、IF），或根据班夫标准进行半定量（IF、TA、AS、AH）。我们计算了移植后1年、2年和3年的肌酐清除率（CrCl）。供体数据包括年龄、性别和类型：非心脏骤停供体或脑死亡供体。受体数据包括年龄、性别、冷缺血时间、HLA错配数、群体反应性抗体（PRA）峰值水平、急性排斥反应发作次数（ARE）以及是否存在巨细胞病毒（CMV）疾病。进行了单变量和多变量分析。随访时间范围为1至4.2年。
在多变量分析中，GS、IF、TA和AH与移植肾存活相关。组织学参数在移植后的几个时间间隔与CrCl相关，但在多变量分析中这种相关性的显著性消失。供体年龄与移植肾功能显示出更好的相关性。在调整供体年龄的单变量分析中，只有IF和AH与移植肾功能相关。
组织学参数与移植肾功能存在适度关联。在我们的研究中，供体年龄是移植肾功能更好的预测指标。作为移植肾结局的预测指标，IF和AH可能与GS相似或优于GS。
