Colussi Giacomo, Casati Costanza, Colombo Valeriana Giuseppina, Camozzi Mario Livio Pietro, Salerno Fabio Rosario
Fabio Rosario Salereno, Division of Nephrology, Dialysis and Renal Transplantatation, ASST Grande Ospedale Territoriale Niguarda, Milan 20162, Italy.
Division of Pathology, ASST Grande Ospedale Territoriale Niguarda, Milan 20162, Italy.
World J Transplant. 2018 Aug 9;8(4):110-121. doi: 10.5500/wjt.v8.i4.110.
To compare survival of kidney transplants from deceased extended criteria donors (ECD) according to: (1) donor graft histological score; and (2) allocation of high score grafts either to single (SKT) or dual (DKT) transplant.
Renal biopsy was performed as part of either a newly adopted DKT protocol, or of surveillance protocol in the past. A total 185 ECD graft recipients were categorized according to pre-implantation graft biopsy into 3 groups: SKT with graft score 1 to 4 [SKT, = 102]; SKT with donor graft score 5 to 8 [SKT, = 30]; DKT with donor graft score 5 to 7 (DKT, = 53). Graft and patient survival were analyzed by Kaplan-Meier curves and compared by log-rank test. Mean number of functioning graft years by transplant reference, and mean number of dialysis-free life years by donor reference in recipients were also calculated at 1, 3 and 6 years from transplantation.
There were no statistically significant differences in graft and patient survival between SKT and SKT, and between SKT and DKT. Recipient renal function (plasma creatinine and creatinine clearance) at 1 years did not differ in SKT and SKT (plasma creatinine 1.71 ± 0.69 and 1.69 ± 0.63 mg/dL; creatinine clearance 49.6 + 18.5 and 52.6 + 18.8 mL/min, respectively); DKT showed statistically lower plasma creatinine (1.46 ± 0.57, < 0.04) but not different creatinine clearance (55.4 + 20.4). Due to older donor age in the DKT group, comparisons were repeated in transplants from donors older than 70 years, and equal graft and patient survival in SKT and DKT were confirmed. Total mean number of functioning graft years by transplant reference at 1, 3 and 6 post-transplant years were equal between the groups, but mean number of dialysis-free life years by donor reference were significantly higher in SKT (mean difference compared to DKT at 6 years: 292 [IQR 260-318] years/100 donors in SKT and 292.5 [(IQR 247.8-331.6) in SKT].
In transplants from clinically suitable ECD donors, graft survival was similar irrespective of pre-implantation biopsy score and of allocation to SKT or DKT. These results suggest use of caution in the use of histology as the only decision criteria for ECD organ allocation.
根据以下两点比较来自已故扩大标准供体（ECD）的肾移植存活率：（1）供体移植物组织学评分；（2）高分移植物分配给单肾移植（SKT）或双肾移植（DKT）。
肾活检作为新采用的DKT方案的一部分，或过去监测方案的一部分进行。总共185例ECD移植物受者根据植入前移植物活检分为3组：移植物评分为1至4的SKT[SKT，n = 102]；供体移植物评分为5至8的SKT[SKT，n = 30]；供体移植物评分为5至7的DKT（DKT，n = 53）。通过Kaplan-Meier曲线分析移植物和患者存活率，并通过对数秩检验进行比较。还计算了移植后1年、3年和6年按移植参考的功能移植物年平均数，以及按供体参考的受者无透析生命年平均数。
SKT与SKT之间以及SKT与DKT之间的移植物和患者存活率无统计学显著差异。1年时SKT与SKT的受者肾功能（血浆肌酐和肌酐清除率）无差异（血浆肌酐分别为1.71±0.69和1.69±0.63mg/dL；肌酐清除率分别为49.6 + 18.5和52.6 + 18.8mL/min）；DKT的血浆肌酐在统计学上较低（1.46±0.57，P<0.04），但肌酐清除率无差异（55.4 +
