Tavakkoli Mahmoud, Yousefi Masoud, Mahdavi Reza, Kalantari Mahmoud Reza, Mirsani Amin, Korooji Amin
Kidney Transplantation Complications Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
Department of Urology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran,
Res Rep Urol. 2019 Apr 26;11:123-130. doi: 10.2147/RRU.S182505. eCollection 2019.
There are several investigations about preimplantation biopsy results in alive donors. However, assessment of the biopsies in deceased donors' kidney and its correlation with patient survival is limited. In this study, we evaluated the correlation between zero-time pretransplant kidney biopsy and survival of kidney in deceased donors.
This was a cohort study conducted at Montaserieh Hospital, Mash-had, between January 2016 and December 2017. We included all brain dead patients who were referred to Montaserieh transplantation center. After vascular anastomosis of kidneys in recipient patients, in the operation room, and de-clumping of vessels, biopsies were taken from upper pole of donated kidney. Blocks of biopsies were evaluated by expert pathologists and then reported. We followed patients for 1 year and compared the pathologic findings and renal survival in them.
The mean age of deceased donors was 32.32±1.49 years and that of the recipient patients was 36.33±1.27 years. Thirty-eight recipient patients (45.2%) were female and 46 were male (54.8%). The most pathologic pattern in our study was grade I separation, followed by blebs, dilatation, and loss of attenuation. We showed that most of the transplantations were safe after 1-year follow-up (85.7%) without any complications. We observed thrombosis in two cases (2.4%) and rejection of transplantation in ten patients (11.9%). Cox regression analysis showed that end-stage renal disease grade (HR =3.84, 95% CI =2.315-6.348; <0.0001) and gender of the deceased donors (HR =0.34, 95% CI =0.145-0.797; =0.013) were related to graft survival rate.
Only cast feature in pathologic exam was related to graft survival, which is a marker of tissue ischemia. There was no significant correlation between other histological findings and graft survival.
关于活体供者的植入前活检结果已有多项研究。然而，对已故供者肾脏活检的评估及其与患者生存率的相关性研究有限。在本研究中，我们评估了移植前零时肾脏活检与已故供者肾脏生存率之间的相关性。
这是一项于2016年1月至2017年12月在马什哈德的蒙塔塞里耶医院进行的队列研究。我们纳入了所有转诊至蒙塔塞里耶移植中心的脑死亡患者。在手术室中，受体患者的肾脏进行血管吻合且血管解凝后，从捐赠肾脏的上极取活检组织。活检组织块由专业病理学家评估后报告结果。我们对患者进行了1年的随访，并比较了他们的病理结果和肾脏生存率。
已故供者的平均年龄为32.32±1.49岁，受体患者的平均年龄为36.33±1.27岁。38名受体患者（45.2%）为女性，46名（54.8%）为男性。我们研究中最常见的病理模式是I级分离，其次是小泡、扩张和衰减丧失。我们发现，1年随访后大多数移植手术是安全的（85.7%），无任何并发症。我们观察到2例（2.4%）出现血栓形成，10例患者（11.9%）发生移植排斥反应。Cox回归分析表明，终末期肾病分级（HR =3.84，95%CI =2.315 - 6.348；<0.0001）和已故供者的性别（HR =0.34，95%CI =0.145 - 0.797；=0.013）与移植物生存率相关。
病理检查中仅管型特征与移植物生存率相关，管型是组织缺血的标志物。其他组织学发现与移植物生存率之间无显著相关性。
