Dienemann Thomas, Schellenberg Jana, Heller Katharina, Daniel Christoph, Amann Kerstin, Hilgers Karl Friedrich, Schiffer Mario, Weidemann Alexander
Medizinische Klinik 4, Nephrologie und Hypertensiologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
Abteilung für Nephropathologie, Pathologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
Clin Transplant. 2019 Oct;33(10):e13697. doi: 10.1111/ctr.13697. Epub 2019 Sep 12.
Transplant centers now accept living donors with well-controlled hypertension. Little is known whether hypertension in living donors affects recipient's kidney function. We aimed to examine potential differences in kidneys from hypertensive donors compared to normotensive donors with respect to renal function over 36 months and histologic findings at transplantation (T0) and 12 months after transplantation (T1). Retrospective single-center analysis of 174 living donor-recipient pairs (age > 18; transplantation date 1/2008-3/2016). Hypertension in donors was defined as being on antihypertensive medication. All biopsies were assessed by the same blinded, experienced renal pathologist. Biopsies were scored for glomerulosclerosis, IFTA, and arteriosclerosis. Regression models were used to examine the relationship of donor hypertension with renal function and histologic changes. Hypertensive donors were significantly older than normotensive donors. Chronic changes such as tubular atrophy and atherosclerosis were more evident in kidneys from hypertensive donors at T0 as well as T1. Donor hypertension was independently associated with histologic changes at T0 and T1 but not with renal function over the follow period. Despite more pronounced histologic changes in kidneys from hypertensive living donors, these grafts exhibited a similar functional outcome. However, they subsequently might be at a greater risk and warrant thorough follow-up care.
移植中心现在接受高血压得到良好控制的活体供者。目前对于活体供者的高血压是否会影响受者的肾功能知之甚少。我们旨在研究与血压正常的供者相比，高血压供者的肾脏在36个月内的肾功能以及移植时（T0）和移植后12个月（T1）的组织学表现的潜在差异。对174对活体供者 - 受者配对（年龄>18岁；移植日期为2008年1月至2016年3月）进行回顾性单中心分析。供者高血压定义为正在服用抗高血压药物。所有活检均由同一位经验丰富的肾脏病理学家进行盲法评估。对活检组织进行肾小球硬化、间质纤维化和动脉硬化评分。使用回归模型来研究供者高血压与肾功能及组织学变化之间的关系。高血压供者明显比血压正常的供者年龄大。在T0和T1时，高血压供者的肾脏中诸如肾小管萎缩和动脉粥样硬化等慢性变化更为明显。供者高血压与T0和T1时的组织学变化独立相关，但与随访期间的肾功能无关。尽管高血压活体供者的肾脏组织学变化更为明显，但这些移植物的功能结果相似。然而，它们随后可能面临更大的风险，需要进行全面的随访护理。
