Hiramitsu Takahisa, Tomosugi Toshihide, Futamura Kenta, Okada Manabu, Tsujita Makoto, Goto Norihiko, Ichimori Toshihiro, Narumi Shunji, Takeda Asami, Watarai Yoshihiko
Department of Transplant and Endocrine Surgery, Nagoya Daini Red Cross Hospital, Showa-ku, Nagoya, Aichi, Japan.
Department of Nephrology, Nagoya Daini Red Cross Hospital, Showa-ku, Nagoya, Aichi, Japan.
Kidney Int Rep. 2019 Oct 10;5(1):13-27. doi: 10.1016/j.ekir.2019.10.002. eCollection 2020 Jan.
Recent reports have described an increased risk of renal disease in living kidney donors compared with the general population. However, these reports do not detail the outcomes of medically complex living donors (MCLDs) with preoperative comorbidities (PCs), such as hypertension, dyslipidemia, glucose intolerance, and obesity. Analysis of living donors with end-stage renal disease (ESRD) has shown that these PCs may contribute significantly to the development of ESRD. We aimed to evaluate the effect of PCs on postoperative renal function and mortality in MCLDs.
Between January 2008 and December 2016, 807 living-donor kidney transplants were performed in our unit. Of these, 802 donors completed postoperative follow-up of >5 months. Donors were stratified into 4 groups based on the number of PCs present: healthy living donors (HLDs) with no PCs ( = 214) or MCLDs with 1 PC ( = 302), 2 PCs ( = 196), or 3 PCs ( = 90) (denoted MCLD [PC 1], MCLD [PC 2], or MCLD [PC 3], respectively). We compared pathology observation data from baseline biopsy, postoperative estimated glomerular filtration rate (eGFR), postoperative urinary protein concentration, and mortality between HLD and MCLD groups.
Interstitial fibrosis, tubular atrophy, glomerulosclerosis, and arteriolosclerosis were more frequent in MCLDs (PC 3) than in HLDs. No significant differences were identified between HLDs and MCLDs in terms of postoperative eGFR and short-term mortality. Overt proteinuria and ESRD were not observed.
Appropriate postdonation management of MCLDs with PCs may result in similar outcomes as for HLDs.
最近的报告显示，与普通人群相比，活体肾供者患肾病的风险有所增加。然而，这些报告并未详细说明术前存在合并症（如高血压、血脂异常、糖耐量异常和肥胖）的医学复杂活体供者（MCLD）的结局。对终末期肾病（ESRD）活体供者的分析表明，这些合并症可能在很大程度上导致ESRD的发生。我们旨在评估合并症对MCLD术后肾功能和死亡率的影响。
2008年1月至2016年12月期间，我们单位共进行了807例活体供肾移植手术。其中，802例供者完成了术后超过5个月的随访。根据存在的合并症数量，将供者分为4组：无合并症的健康活体供者（HLD，n = 214）或合并1种合并症的MCLD（n = 302）、2种合并症的MCLD（n = 196）或3种合并症的MCLD（n = 90）（分别表示为MCLD[PC 1]、MCLD[PC 2]或MCLD[PC 3]）。我们比较了HLD组和MCLD组基线活检的病理观察数据、术后估计肾小球滤过率（eGFR）、术后尿蛋白浓度和死亡率。
MCLD（PC 3）组的间质纤维化、肾小管萎缩、肾小球硬化和小动脉硬化比HLD组更常见。HLD组和MCLD组在术后eGFR和短期死亡率方面未发现显著差异。未观察到明显蛋白尿和ESRD。
对合并合并症的MCLD进行适当的供肾后管理可能会产生与HLD相似的结局。
