a Department of Nephrology and Transplantation , Beaumont Hospital , Dublin , Ireland.
b Royal College of Surgeons , Dublin , Ireland.
Ren Fail. 2017 Nov;39(1):671-677. doi: 10.1080/0886022X.2017.1363778.
Pre-implant kidney biopsy is used to determine suitability of marginal donor kidneys for transplantation. However, there is limited data examining the utility of pre-implant histology in predicting medium term graft outcome. This retrospective study examined kidney transplants over a 10-year period at a single center to determine if pre-implant histology can identify cases of eGFR ≤35 ml/min/1.73m at 5 year follow up beyond a clinical predictive logistic regression model. We also compared outcomes of dual kidney transplants with standard single kidney transplants. Of 1195 transplants, 171 received a pre-implant kidney biopsy and 15 were dual transplants. There was no significant difference in graft and patient survival rates. Median eGFR was lower in recipients of biopsied kidneys compared with standard kidney transplants (44 vs. 54 ml/min/1.73m, p < .001). Median eGFR of dual transplant and standard kidney transplants were similar (58 vs. 54 ml/min/1.73m, p = .64). Glomerular sclerosis (p = .05) and Karpinski Score (p = .03) were significant predictors of eGFR at 5-years in multivariate analysis but did not improve discrimination of eGFR ≤35 ml/min/1.73m at 5-years beyond a clinical prediction model comprising donor age, donor hypertension and terminal donor creatinine (C-statistic 0.67 vs. 0.66; p = .647). Pre-implant histology did not improve prediction of medium-term graft outcomes beyond clinical predictors alone. Allograft function of dual transplant kidneys was similar to standard transplants, suggesting that there is scope to increase utilization of kidneys considered marginal based on histology.
移植前肾活检用于确定边缘供体肾脏是否适合移植。然而，关于移植前组织病理学在预测中期移植物结局方面的应用，目前仅有有限的数据。本回顾性研究分析了 10 年间单中心的肾移植病例，以确定移植前组织学是否能在临床预测逻辑回归模型之外，预测 5 年随访时 eGFR≤35ml/min/1.73m2 的病例。我们还比较了双肾移植与标准单肾移植的结果。在 1195 例移植中，171 例接受了移植前肾活检，15 例为双肾移植。移植肾和患者存活率无显著差异。与标准肾移植相比，接受活检的移植肾 recipients 的 eGFR 中位数较低（44 与 54ml/min/1.73m2，p<0.001）。双肾移植和标准肾移植的 eGFR 中位数相似（58 与 54ml/min/1.73m2，p=0.64）。肾小球硬化（p=0.05）和 Karpinski 评分（p=0.03）在多变量分析中是 5 年时 eGFR 的显著预测因素，但不能改善基于供体年龄、供体高血压和终末期供体肌酐的临床预测模型对 5 年时 eGFR≤35ml/min/1.73m2 的预测能力（C 统计量 0.67 与 0.66；p=0.647）。移植前组织学不能改善独立于临床预测因素的中期移植物结局预测。双移植肾的同种异体移植物功能与标准移植相似，这表明有扩大利用基于组织学认为是边缘供体的肾脏的余地。
