Servicio de Nefrología, Hospital Universitario Reina Sofía, Córdoba, Spain.
Transplantation. 2011 Feb 27;91(4):432-9. doi: 10.1097/TP.0b013e318204bdd7.
The shortage of organs has led to expanding the criteria for donors. Histologic evaluations before transplantation may enable the identification of organs unsuitable for single implantation. The aim of this study was to evaluate the histologic findings as prognostic factors of allograft survival from expanded criteria donors (ECDs).
We included a cohort of 136 single transplantations with kidneys from ECD and correlated the preimplantation pathologic findings with graft failure. Renal structures from ECD older (n=104) or younger (n=32) than 60 years were evaluated histologically for renal senescence and rated with a total histologic score. A multivariate Cox analysis was performed to identify predictors of graft failure.
Glomerulosclerosis was the most prevalent lesion in biopsies from donors older and younger than 60 years (P=0.002); interstitial fibrosis was more severe in biopsies from older donors (P=0.001); older donors showed a higher prevalence of tubular atrophy (P=0.022), and vascular compartment showed no significant differences. Kidney biopsy-based scoring system ranged from 0 to 15 points, indicating the presence of changes in the renal parenchyma. Biopsies with total histologic scores less than or equal to 5 showed significantly better 5-year graft survival than those with scores more than 5 (P<0.001). A preimplantation score more than 5 points remained an independent predictor of graft failure (hazard ratio 6.95; 95% confidence interval 1.57-30).
Histologic analysis of kidney biopsies before transplantation is a valuable tool for facilitating the selection of viable grafts from ECD donors. When the total score is more than 5, single kidney transplantation from ECD should not be recommended for patients similar to this study population.
器官短缺导致供体标准扩大。移植前的组织学评估可能有助于识别不适合单器官移植的器官。本研究旨在评估组织学发现作为扩大标准供体（ECD）同种异体移植物存活的预后因素。
我们纳入了 136 例来自 ECD 的单器官移植队列，并将移植前的病理发现与移植物失功相关联。对年龄大于（n=104）或小于（n=32）60 岁的 ECD 肾组织进行组织学评估，以评估肾衰老并进行总组织学评分。进行多变量 Cox 分析以确定移植物失功的预测因素。
肾小球硬化是来自年龄大于和小于 60 岁供者的活检中最常见的病变（P=0.002）；间质纤维化在年龄较大供者的活检中更为严重（P=0.001）；年龄较大的供者表现出更高的肾小管萎缩发生率（P=0.022），而血管腔室无明显差异。基于肾脏活检的评分系统范围为 0 至 15 分，表明肾实质存在变化。总组织学评分小于或等于 5 分的活检与评分大于 5 分的活检相比，5 年移植物存活率显著更高（P<0.001）。移植前评分大于 5 分仍然是移植物失功的独立预测因素（危险比 6.95；95%置信区间 1.57-30）。
移植前肾脏活检的组织学分析是从 ECD 供体中选择有活力移植物的有价值工具。当总评分大于 5 时，对于与本研究人群相似的患者，不建议从 ECD 进行单器官移植。
