在血糖控制良好的肾移植受者中，持续的供体传播糖尿病肾病：一项单中心回顾性研究。
Ongoing donor-transmitted diabetic kidney disease in kidney transplant recipients with fair sugar control: a single center retrospective study.
机构信息
Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
出版信息
BMC Nephrol. 2020 Nov 3;21(1):458. doi: 10.1186/s12882-020-02132-w.
BACKGROUND
Transplantation with a diabetic donor kidney may have some benefits compared to remaining on the waitlist for selected patients. However, we found that some kidney transplant recipients have ongoing donor-transmitted diabetic kidney disease (DT-DKD) despite fair blood sugar control. This study aimed to survey the incidence and clinical pattern of DT-DKD in kidney transplant recipients.
METHODS
We retrospectively reviewed the medical records of kidney transplantations in our hospital. We found 357 kidney transplantations from February 2006 to April 2018. Among these, 23 (6.4%) diabetic donor kidney transplantations were done in the study period.
RESULTS
Among the 23 recipients, 6 (26.1%) displayed biopsy-proven DKD. Recipients with biopsy-proven DKD had longer dialysis vintage, higher proteinuria amount, lower last estimated glomerular filtration rate (eGFR), and a more rapid decline in the eGFR. The median fasting blood sugar level in the biopsy-proven DKD group was unexpectedly lower than the non-DKD group. Most of the pre-implantation frozen sections in biopsy-proven DKD group showed diabetic lesions worse than diabetic nephropathy (DN) class IIa. In the biopsy-proven DKD group, 5 recipients had no history of diabetes before or after transplantation. Among the 23 recipients, 5 (21.7%) were diagnosed with DT-DKD. Serial post-transplant biopsies showed the histological progression of allograft DN.
CONCLUSIONS
To the best of our knowledge, this is the first study to report the phenomenon of ongoing DT-DKD in kidney transplant recipients with fair blood sugar control. The zero-time pre-transplant kidney biopsy may be an important examination before the allocation of diabetic donor kidneys. Further study is needed to elucidate the possible mechanism of ongoing DT-DKD in non-diabetic recipients with fair blood sugar control as well as the impaction of pre-implantation diabetic lesion on the graft outcome.
背景
与在等待名单上等待相比，对于某些患者，接受糖尿病供体的肾脏移植可能具有一些益处。然而，我们发现，尽管血糖控制良好，但一些肾移植受者仍存在持续的供体传递性糖尿病肾病（DT-DKD）。本研究旨在调查肾移植受者中 DT-DKD 的发生率和临床模式。
方法
我们回顾性地审查了我院的肾移植病历。我们发现，在 2006 年 2 月至 2018 年 4 月期间进行了 357 例肾移植手术。在这些患者中，有 23 例（6.4%）糖尿病供体肾移植在研究期间进行。
结果
在 23 名受者中，有 6 名（26.1%）经活检证实为 DKD。经活检证实患有 DKD 的受者的透析时间更长，蛋白尿量更多，最后估计肾小球滤过率（eGFR）更低，eGFR 下降速度更快。活检证实 DKD 组的空腹血糖中位数水平出人意料地低于非 DKD 组。活检证实 DKD 组中大多数移植前冷冻切片显示的糖尿病病变比糖尿病肾病（DN）IIa 级更严重。在活检证实 DKD 组中，有 5 名受者在移植前后均无糖尿病病史。在 23 名受者中，有 5 名（21.7%）被诊断为 DT-DKD。连续的移植后活检显示同种异体 DN 的组织学进展。
结论
据我们所知，这是第一项报告血糖控制良好的肾移植受者中持续存在 DT-DKD 的现象的研究。零时间的移植前肾活检可能是分配糖尿病供体肾脏之前的重要检查。需要进一步研究阐明血糖控制良好的非糖尿病受者中持续存在的 DT-DKD 的可能机制，以及移植前糖尿病病变对移植物预后的影响。
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