Tavares da Silva E, Oliveira R, Castelo D, Marques V, Sousa V, Moreira P, Simões P, Bastos C A, Figueiredo A, Mota A
Urology and Renal Transplantation Department, Coimbra's Hospital and University Center, Coimbra, Portugal.
Pathology Department, Coimbra's Hospital and University Center, Coimbra, Portugal.
Transplant Proc. 2014 Dec;46(10):3330-4. doi: 10.1016/j.transproceed.2014.10.026.
Renal transplantation is the best treatment for end-stage renal disease, including when using expanded criteria donors (ECD) kidneys. However, these suboptimal kidneys should be evaluated rigorously to meet their usefulness. Opinions differ about the best way to evaluate them.
We retrospectively reviewed kidneys from ECD harvested by a single academic institution between January 2008 and September 2013. Needle biopsies were performed at the time of the harvest when considered relevant by the transplant team. Two pathologists where responsible for their analysis; the Remuzzi classification has been used in all cases.
We evaluated 560 ECD kidneys. Biopsies were made in 197 (35.2%) organs, 20 of which were considered not usable and 36 good only for double transplantation. Sixty-three kidneys (11.3%) were discarded by the transplant team based on the biopsy result and clinical criteria. Donors who underwent a biopsy were older (P < .001) and had a worse glomerular filtration rate (GFR; P = .001). Comparing donors approved and rejected by the biopsy, the rejected donors were heavier (P = .003) and had a lower GFR (P = .002). Cold ischemia time was longer for the biopsy group (P < .001). Regarding graft function, the biopsy overall score correlated with the transplant outcome in the short and long term. Separately, glomeruli and interstitium scores were correlated with recipient's GFR in the earlier periods (3 months; P = .025 and .037), and the arteries and tubules correlated with GFR in the longer term (at 3 years P = .004 and .010).
The decision on the usability of ECD grafts is complex. At our center, we chose a mixed approach based on donor risk. Low-risk ECD do not require biopsy. In more complex situations, especially older donors or those with a lower GFR, prompted a pretransplant biopsy. The biopsy results proved to be useful as they relate to subsequent transplant outcomes, thereby allowing us to exclude grafts whose function would most probably be less than optimal.
肾移植是终末期肾病的最佳治疗方法，包括使用扩大标准供体（ECD）肾脏时。然而，这些质量稍差的肾脏应经过严格评估以确定其可用性。对于评估它们的最佳方法，各方意见不一。
我们回顾性分析了2008年1月至2013年9月间由单一学术机构获取的ECD肾脏。移植团队认为有必要时，在获取肾脏时进行了穿刺活检。由两名病理学家负责分析；所有病例均采用雷穆齐分类法。
我们评估了560个ECD肾脏。197个（35.2%）器官进行了活检，其中20个被认为不可用，36个仅适合双肾移植。移植团队根据活检结果和临床标准丢弃了63个肾脏（11.3%）。接受活检的供体年龄更大（P <.001），肾小球滤过率（GFR）更差（P =.001）。比较活检批准和拒绝的供体，被拒绝的供体体重更重（P =.003），GFR更低（P =.002）。活检组的冷缺血时间更长（P <.0)。关于移植肾功能，活检总体评分与短期和长期移植结果相关。单独来看，肾小球和间质评分在早期（3个月；P =.025和.037）与受者的GFR相关，动脉和肾小管评分在长期（3年时P =.004和.010）与GFR相关。
ECD移植物可用性的决策很复杂。在我们中心，我们基于供体风险选择了一种混合方法。低风险ECD不需要活检。在更复杂的情况下，尤其是年龄较大的供体或GFR较低的供体，促使进行移植前活检。活检结果被证明是有用的，因为它们与随后的移植结果相关，从而使我们能够排除那些功能很可能不太理想的移植物。
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