Divisions of Nephrology, University of Alberta, Edmonton, Alberta, Canada.
Transplantation. 2010 Mar 15;89(5):559-66. doi: 10.1097/TP.0b013e3181ca7e9b.
Uncertainty remains in the prognostic utility of biopsies of deceased donor kidneys in predicting graft outcomes.
We examined implantation biopsies for 730 kidney transplant recipients from 491 deceased donors from 1990 to 2004. The median follow-up time was 5.1 years. Of the 730 transplants, 633 (86.7%) had implantation biopsies (wedge 89.1%). Of these 633, 541 (85.5%) could be assessed for % glomerulosclerosis (GS), interstitial fibrosis, tubular atrophy, arteriolar hyalinosis, and fibrous intimal thickening. Independent risk factors for delayed graft function include regraft, longer cold ischemia time, and DR mismatch, but not donor age. Independent risk factors for worse function at 6 months include regraft, older donor and recipient, female donor and recipient, and rejection. Independent risk factors of graft failure include regraft, older donor age, male recipient, and rejection.
Of the histologic scores, arteriolar hyalinosis was independently associated with delayed graft function and graft loss, whereas fibrous intimal thickening was associated with decreased 6-month renal function. Importantly, the degree of GS was not independently associated with outcomes.
Therefore, although biopsy evidences of vascular pathologic condition, kidney may contribute meaningfully to the assessment of donor quality but the degree of GS does not.
在预测移植物结局方面，对于来自已故供体的肾脏活检在预后中的作用仍然存在不确定性。
我们检查了 1990 年至 2004 年间来自 491 名已故供体的 730 名肾移植受者的植入活检。中位随访时间为 5.1 年。在 730 例移植中，633 例（86.7%）进行了植入活检（楔形 89.1%）。在这 633 例中，541 例（85.5%）可评估肾小球硬化（GS）、间质纤维化、肾小管萎缩、血管玻璃样变和纤维性内膜增厚的百分比。延迟移植物功能的独立危险因素包括再次移植、较长的冷缺血时间和 DR 错配，但不包括供体年龄。6 个月时功能恶化的独立危险因素包括再次移植、供体和受者年龄较大、女性供体和受者、以及排斥反应。移植物衰竭的独立危险因素包括再次移植、供体年龄较大、男性受者和排斥反应。
在组织学评分中，血管玻璃样变与延迟移植物功能和移植物丢失独立相关，而纤维性内膜增厚与 6 个月时肾功能下降相关。重要的是，GS 的程度与结局没有独立的相关性。
因此，尽管活检证据表明血管病理状况，但肾脏可能对供体质量的评估有重要意义，但 GS 的程度没有。
