Division of Nephrology and Dialysis, Department of CardioRenal and Cerebrovascular Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan.
Am J Nephrol. 2012;36(2):127-35. doi: 10.1159/000340035. Epub 2012 Jul 13.
Donor shortage is a serious problem worldwide and it is now debated whether kidneys from marginal donors are suitable for renal transplantation. Recent studies have shown that the findings of preimplantation kidney biopsy are useful to evaluate vasculopathy in the donated kidney, and may predict transplant outcomes in deceased- donor kidney transplantation. However, few studies have focused on the pathological findings of preimplantation biopsy in living-donor kidney transplantation. Therefore, we investigated whether arteriosclerotic vasculopathy in living-donor kidneys at the time of transplantation predicts the recipient's kidney function (allograft function) later in life.
We retrospectively analyzed 75 consecutive adult living-donor kidney transplants performed at Kagawa University Hospital. Renal arteriosclerotic vasculopathy was defined according to the presence of fibrous intimal thickening in the interlobular artery.
Forty-one kidneys exhibited mild arteriosclerotic vasculopathy on preimplantation kidney biopsies. The decreases in estimated glomerular filtration rate after donation were similar in donors with or without renal arteriosclerotic vasculopathy. Pre-existing arteriosclerotic vasculopathy did not affect graft survival rate, patient survival rate or the incidence of complications. Recipients of kidneys with arteriosclerotic vasculopathy had lower allograft function at 1 and 3 years after transplantation than the recipients of arteriosclerosis-free kidneys with or without donor hypertension. In multivariate analysis, fibrous intimal thickening on preimplantation biopsy was predictive of reduced allograft function at 1 year after transplantation.
The present study demonstrated that mild arteriosclerotic vasculopathy in the donated kidney is an important pathological factor that reflects future impaired function of renal allografts from marginal donors.
供体短缺是一个全球性的严重问题，现在人们正在争论边缘供体的肾脏是否适合肾移植。最近的研究表明，移植前肾脏活检的结果有助于评估供体肾脏的血管病变，并可能预测尸肾移植的移植结局。然而，很少有研究关注活体供肾移植前移植活检的病理发现。因此，我们研究了移植时活体供肾的动脉粥样硬化性血管病变是否可以预测受者日后的肾功能（移植物功能）。
我们回顾性分析了在香川大学医院进行的 75 例连续成人活体供肾移植。根据小叶间动脉中纤维内膜增厚的存在来定义肾动脉粥样硬化性血管病变。
41 例肾脏在移植前的肾脏活检中显示轻度动脉粥样硬化性血管病变。供体有或没有肾动脉粥样硬化性血管病变，捐赠后肾小球滤过率的下降相似。预先存在的动脉粥样硬化性血管病变并不影响移植物存活率、患者存活率或并发症的发生率。与无动脉粥样硬化的供体高血压的供体相比，有动脉粥样硬化的供体的受者在移植后 1 年和 3 年的移植物功能较低。多变量分析显示，移植前活检中的纤维内膜增厚是预测移植后 1 年移植物功能下降的一个重要因素。
本研究表明，供体肾脏的轻度动脉粥样硬化性血管病变是一个重要的病理因素，反映了边缘供体的肾移植物未来功能受损。
