Nephrology and Renal Transplant Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.
Pathology Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.
Transpl Int. 2017 Oct;30(10):975-986. doi: 10.1111/tri.12966. Epub 2017 Jun 2.
There is no consensus on the allocation of renal transplants from expanded criteria donors (ECD). The Kidney Donor Profile Index (KDPI) is used without the need for pretransplant donor biopsies (PTDB). We explored whether PTDB based on Remuzzi Score (RS) allows identification of those marginal kidneys in the highest calculated KDPI risk group (>91%) that appropriate for single transplantation. A retrospective study was conducted of 485 consecutive kidneys procured from a single center and transplanted if the RS was ≤4. We compared 5-year kidney and patients survival between KDPI groups and between RS <4 or =4 in the highest KDPI group. The median KDPI (interquartile range) was 71 (66-76) for KDPI <80% (n = 77), 86 (81-90) for KDPI 81-90% (n = 82), and 97 (94-100) for KDPI >91% (n = 205). Patient survival at 5 years was 85.7%, 85.3%, and 76.09% (P = 0.058) and death-censored graft survival was 84.4%, 86.5%, 73.6% (P = 0.015), respectively for each KDPI group. In >91% calculated KDPI group, there were no differences in graft survival depending on the RS (<4 vs. =4) (P = 0.714). The implementation of PTDB based on RS used for allocation of organs with the highest KDPI range could support to the acceptance of suitable organs for single transplantation with good patient and graft survival rate.
对于来自扩展标准供体的肾移植，目前尚无共识。肾移植供体状况指数（KDPI）可用于预测移植肾的预后，而无需进行移植前供体活检（PTDB）。本研究旨在探讨基于雷米兹评分（RS）的 PTDB 是否能够识别出 KDPI 计算风险最高（>91%）组中适合进行单器官移植的边缘肾脏。对来自单中心的 485 例连续肾脏进行回顾性研究，仅当 RS≤4 时才进行移植。比较了 KDPI 组间、KDPI 最高组中 RS<4 与 RS=4 间的 5 年患者和移植物存活率。KDPI<80%组的 KDPI 中位数（四分位间距）为 71（66-76），KDPI 81-90%组为 86（81-90），KDPI>91%组为 97（94-100）。5 年患者存活率分别为 85.7%、85.3%和 76.09%（P=0.058），死亡相关移植物存活率分别为 84.4%、86.5%和 73.6%（P=0.015）。在 KDPI 计算值>91%的组中，根据 RS（<4 与 =4），移植物存活率无差异（P=0.714）。根据 RS 对 KDPI 最高范围内的器官进行分配，实施 PTDB 可支持接受适合单器官移植的合适器官，从而获得良好的患者和移植物存活率。
