Esposito C, Migotto C, Torreggiani M, Maggi N, Manini A, Castoldi F, Grosjean F, Mangione F, Abelli M, Scaramuzzi M L, Catucci D, Dal Canton A
Department of Policlinico San Matteo and Nephrology and Hemodialysis, Fondazione S. Maugeri, University of Pavia, Pavia, Italy.
Transplant Proc. 2012 Sep;44(7):1889-91. doi: 10.1016/j.transproceed.2012.07.091.
Although many variables may affect long-term graft survival no biomarker is available to identify donor kidney with poor quality and with inadequate short and long-term outcome. While in marginal donors pre-transplant renal biopsies are commonly performed to establish if donor kidneys are suitable for transplantation they are not performed in standard donors. In this study we assessed the relevance of pre-transplant morphological features on post-transplant renal function and evaluated the association between perioperative parameters with posttransplant histological and clinical findings. Kidney transplant recipients undergone pre-transplant and post transplant protocol biopsies at 1, 6, and 12 months were enrolled in the study. Perioperative and posttransplant clinical and biochemical parameters were recorded. Semiquantitative analysis of PAS stained kidney sections was used to determine the degree of lesions. Glomerular volume was measured by computed morphometry. A strong inverse correlation was found between donor age and renal graft function at 1, 6, and 12 months after transplantation. A prompt functional recovery was associated with a better renal function at 6 months and one year. Kidneys with higher glomerular volume demonstrated a lower serum creatinine at 1 month. Higher tubulo-interstitial grading at protocol biopsies was associated with a poor renal function at 1 month. Our findings confirm the importance of donor age in kidney transplant long-term outcome and demonstrate that pretransplant and protocol biopsies are valid options to determine graft outcome and to define therapeutic strategies and tailor immunosuppressive regimen for each patient.
尽管许多变量可能影响移植肾的长期存活，但目前尚无生物标志物可用于识别质量不佳、短期和长期预后不良的供肾。对于边缘供体，通常在移植前进行肾活检以确定供肾是否适合移植，但标准供体不进行此项检查。在本研究中，我们评估了移植前形态学特征对移植后肾功能的相关性，并评估了围手术期参数与移植后组织学和临床结果之间的关联。接受移植前及移植后1、6和12个月方案活检的肾移植受者被纳入研究。记录围手术期和移植后的临床及生化参数。采用对PAS染色的肾切片进行半定量分析来确定病变程度。通过计算机形态测量法测量肾小球体积。发现供体年龄与移植后1、6和12个月时的肾移植功能呈强烈负相关。快速的功能恢复与6个月和1年时更好的肾功能相关。肾小球体积较大的肾脏在1个月时血清肌酐较低。方案活检时较高的肾小管间质分级与1个月时较差的肾功能相关。我们的研究结果证实了供体年龄在肾移植长期预后中的重要性，并表明移植前和方案活检是确定移植结果、制定治疗策略以及为每位患者量身定制免疫抑制方案的有效选择。
