Lin N C, Yang A H, King K L, Wu T H, Yang W C, Loong C C
Department of Surgery, Division of Transplantation Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
Transplant Proc. 2010 Nov;42(9):3382-6. doi: 10.1016/j.transproceed.2010.08.053.
Deceased-donor kidney transplantation (DDKT) from high-terminal creatinine donors is associated with lower graft survival. These kidneys may be considered for discarding, worsening the organ shortage crisis. Using time-zero biopsy for histologic evaluation of these kidneys, we identified those organs eligible for transplantation, seeking to achieve better graft utility with comparable outcomes.
From April 2004 to April 2008, 55 patients underwent DDKT. A time-zero biopsy was used to examine glomerulosclerosis, interstitial fibrosis, tubular atrophy, and arteriolar narrowing. A scoring system was used to determine a discard.
Twenty-five patients received DDKT from donors whose terminal creatinine levels were >2.0 mg/dL (high terminal creatinine, HTC group) and 30 from donors whose terminal creatinine levels were <2.0 mg/dL (low terminal creatinine, LTC group). Patients who accepted kidneys from HTC donors had shorter waiting times (P = .011) but a higher incidence of delayed graft function after transplantation (P < .001). Nonetheless, 5-year graft survival rates were similar between the two groups.
With a time-zero biopsy for histologic evaluation, kidneys recovered from high-terminal creatinine donors can be transplanted to overcome the organ shortage while achieving reasonable graft survival.
来自高血清肌酐终末期供体的尸体供肾移植（DDKT）与较低的移植物存活率相关。这些肾脏可能会被考虑丢弃，从而加剧器官短缺危机。通过零时间活检对这些肾脏进行组织学评估，我们确定了那些适合移植的器官，旨在以可比的结果实现更好的移植物利用率。
2004年4月至2008年4月，55例患者接受了DDKT。采用零时间活检来检查肾小球硬化、间质纤维化、肾小管萎缩和小动脉狭窄。使用评分系统来确定是否丢弃。
25例患者接受了来自终末期肌酐水平>2.0mg/dL供体的DDKT（高血清肌酐终末期，HTC组），30例患者接受了来自终末期肌酐水平<2.0mg/dL供体的DDKT（低血清肌酐终末期，LTC组）。接受HTC供体肾脏的患者等待时间较短（P = 0.011），但移植后移植肾功能延迟的发生率较高（P < 0.001）。尽管如此，两组的5年移植物存活率相似。
通过零时间活检进行组织学评估，从高血清肌酐终末期供体获取的肾脏可以进行移植，以克服器官短缺问题，同时实现合理的移植物存活率。
