Department of Nephrology and Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Department of Histopathology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Transpl Int. 2019 May;32(5):523-534. doi: 10.1111/tri.13398. Epub 2019 Feb 8.
The use of preimplantation kidney biopsies (PIKBs) to aid deceased donor kidney utilization decisions is controversial. Outcomes of transplants that had been biopsied after the decision had been made to implant were analysed, in order to determine the association between chronic histological changes at implantation and graft outcomes. A retrospective analysis of transplants between the year range 2006-2015 was performed. Karpinski scores on biopsies were collected, and graft outcomes were analysed using univariate and multivariable techniques. Also, Karpinski scores from single and dual kidney transplants from older donors were examined to determine if knowledge of the score preoperatively would have altered utilization. Four hundred and eight single kidneys were transplanted. Although kidneys with scores >4 had lower 1- and 3-year median (IQR) estimated glomerular filtration rates (eGFRs) than those scoring 0-4 (51 (37-66) vs. 35 (26-52) ml/min/1.73 m , P < 0.001, and 52 (34-64) vs. 35 (24-52) ml/min/1.73 m , P < 0.001, respectively), there was no significant association between Karpinski score and death-censored graft survival on univariate or multivariable analyses. The utilization analysis (75 single and 25 dual kidney transplant recipients) suggested that systematic use of PIKBs would have resulted in 29% fewer patients being transplanted. This analysis does not support the systematic use of PIKBs to determine deceased donor kidney utilization.
使用植入前肾脏活检（PIKB）来辅助决定已故供体肾脏的利用存在争议。对已经决定植入后进行活检的移植的结果进行了分析，以确定植入时慢性组织学变化与移植物结局之间的关系。对 2006-2015 年期间的移植进行了回顾性分析。收集了活检的 Karpinski 评分，并使用单变量和多变量技术分析了移植物结局。还检查了来自老年供体的单肾和双肾移植的 Karpinski 评分，以确定术前是否了解该评分会改变利用情况。共移植了 408 个单肾。尽管评分>4 的肾脏的 1 年和 3 年中位数（IQR）估算肾小球滤过率（eGFR）低于评分 0-4 的肾脏（51（37-66）比 35（26-52）ml/min/1.73m ，P<0.001 和 52（34-64）比 35（24-52）ml/min/1.73m ，P<0.001），但在单变量和多变量分析中，Karpinski 评分与死亡风险调整的移植物存活率之间没有显著关联。利用分析（75 名单肾和 25 名双肾移植受者）表明，系统使用 PIKB 会导致 29%的患者被移植。这项分析不支持系统使用 PIKB 来决定已故供体肾脏的利用。
