Auglienė Rūta, Dalinkevičienė Eglė, Kuzminskis Vytautas, Jievaltas Mindaugas, Peleckaitė Laima, Gryguc Agnė, Stankevičius Edgaras, Bumblytė Inga Arūnė
Department of Nephrology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Department of Nephrology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Medicina (Kaunas). 2017;53(4):224-232. doi: 10.1016/j.medici.2017.07.003. Epub 2017 Jul 29.
The demand for kidney transplants exceeds the existing supply. This leads to a recently growing interest of research in the area of factors that could prolong graft long-term outcomes and survival. In Lithuania, approximately 90% of kidney transplantations are from deceased donors. Donor organs are received and shared only inside the country territory in Lithuania; therefore, donor data is accurate and precise. This study was performed to present particularities of kidney transplantation data in Lithuania and to identify the effect of donor and recipient factors and histologic findings on renal graft outcomes. The aim of this study was to identify the effect of donor and recipient factors and histologic findings on renal graft outcomes.
We analyzed the influence of deceased donor and recipient factors and histological findings on the graft function in 186 renal transplant patients. Graft survival was estimated within the first year after transplantation.
The donors and recipients were older in worse eGFR group 1 year after transplantation. Dissimilarity of degree of glomerulosclerosis (GS), interstitial fibrosis (IF) and arteriolar hyalinosis (AH) were significant in inferior and superior renal function groups (GS >20% 11.4 vs. 0%, P=0.017; IF 9.3 vs. 0%, P=0.034; AH 69 vs. 26.2%, P<0.001). Nine independent variables were significantly associated with a worse renal transplant function 1 year posttransplantation: AH (OR=6.287, P<0.001), an episode of urinary tract infection (OR=2.769, P=0.020), acute graft rejection (OR=3.605, P=0.037), expanded criteria (OR=4.987, P=0.001), female gender donors (OR=3.00, P=0.014), cerebrovascular disease caused donor brain death (OR=5.00, P=0.001), donor's age (OR=1.07, P<0.001), and recipient's age (OR=1.047, P=0.022). Worse renal graft survival 1 year posttransplantation was associated with a delayed graft function and a higher level of glomerulosclerosis in time-zero biopsy.
Donor factors, such as age, female gender, brain death of cerebrovascular cause and expanded criteria donor status had a significant negative impact on the renal graft function 1 year after transplantation. Recipients' age, urinary tract infection and acute graft rejection episodes after transplantation were associated with a worse kidney function 1 year after transplantation. Lower 1-year graft survival was related to a delayed graft function (DGF) and a higher degree of glomerulosclerosis.
肾移植的需求超过了现有的供应。这导致最近在可能延长移植长期结果和存活率的因素领域的研究兴趣日益增加。在立陶宛，约90%的肾移植来自已故供体。在立陶宛，供体器官仅在国内接收和共享；因此，供体数据准确精确。本研究旨在呈现立陶宛肾移植数据的特点，并确定供体和受体因素以及组织学发现对肾移植结果的影响。本研究的目的是确定供体和受体因素以及组织学发现对肾移植结果的影响。
我们分析了186例肾移植患者中已故供体和受体因素以及组织学发现对移植肾功能的影响。在移植后的第一年内评估移植存活率。
移植1年后，估算肾小球滤过率（eGFR）较差的组中供体和受体年龄更大。肾小球硬化（GS）、间质纤维化（IF）和小动脉玻璃样变（AH）程度在肾功能较差和较好组之间存在显著差异（GS>20% 为11.4% 对0%，P = 0.017；IF为9.3% 对0%，P = 0.034；AH为69% 对26.2%，P<0.001）。九个独立变量与移植后1年较差的肾移植功能显著相关：AH（比值比[OR]=6.287，P<0.001）、尿路感染发作（OR = 2.769，P = 0.020）、急性移植排斥（OR = 3.605，P = 0.037）、扩大标准（OR = 4.987，P = 0.001）、女性供体（OR = 3.00，P = 0.014）、脑血管疾病导致的供体脑死亡（OR = 5.00，P = 0.001）、供体年龄（OR = 1.07，P<0.001）以及受体年龄（OR = 1.047，P = 0.022）。移植后1年较差的肾移植存活率与移植功能延迟以及零时活检时较高水平的肾小球硬化有关。
供体因素，如年龄、女性性别、脑血管原因导致的脑死亡以及扩大标准供体状态，对移植后1年的肾移植功能有显著负面影响。受体年龄、尿路感染以及移植后的急性移植排斥发作与移植后1年较差的肾功能有关。较低的1年移植存活率与移植功能延迟（DGF）和较高程度的肾小球硬化有关。
