Department of Pathology, Maastricht University Medical Center, University of Maastricht, Maastricht, The Netherlands.
Department of Surgery-Organ Donation and Transplantation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Transplantation. 2020 Dec;104(12):2567-2574. doi: 10.1097/TP.0000000000003189.
During organ retrieval, surgeons estimate the degree of arteriosclerosis and this plays an important role in decisions on organ acceptance. Our study aimed to elucidate the association between macroscopic renal artery arteriosclerosis, donor kidney discard, and transplant outcome.
We selected all transplanted and discarded kidneys in the Netherlands between January 1, 2000, and December 31, 2015, from deceased donors aged 50 y and older, for which data on renal artery arteriosclerosis were available (n = 2610). The association between arteriosclerosis and kidney discard, the relation between arteriosclerosis and outcome, and the correlation between macroscopic and microscopic arteriosclerosis were explored.
Macroscopic arteriosclerosis was independently associated with kidney discard (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.02-1.80; P = 0.03). Arteriosclerosis (any degree) was not significantly associated with delayed graft function (OR, 1.16; 95% CI, 0.94-1.43; P = 0.16), estimated glomerular filtration rate 1-y posttransplant (B, 0.58; 95% CI, -2.07 to 3.22; P = 0.67), and long-term graft survival (hazard ratio, 1.07; 95% CI, 0.86-1.33; P = 0.55). There was a significant association between mild arteriosclerosis and primary nonfunction (OR, 2.14; 95% CI, 1.19-3.84; P = 0.01). We found no correlation between macroscopic and histological arteriosclerosis, nor between histological arteriosclerosis and transplant outcome.
Macroscopic arteriosclerosis of the renal artery was independently associated with kidney discard and somewhat associated with primary nonfunction posttransplant. However, there was no effect of arteriosclerosis on delayed graft function, estimated glomerular filtration rate at 1 y, or long-term graft survival. Our results are valid only after inevitable exclusion of discarded kidneys that had on average more arteriosclerosis. Hence, conclusions should be interpreted in the light of this potential bias.
在器官获取过程中，外科医生会评估动脉硬化程度，这对器官接受决策起着重要作用。我们的研究旨在阐明肾动脉宏观动脉硬化、供肾废弃与移植结果之间的关系。
我们从 2000 年 1 月 1 日至 2015 年 12 月 31 日期间选择了所有年龄在 50 岁及以上的已故供者的移植和废弃的肾脏，这些供者的数据中包含肾动脉动脉硬化情况（n=2610）。我们探讨了动脉硬化与供肾废弃之间的关系、动脉硬化与移植结果之间的关系以及宏观和微观动脉硬化之间的相关性。
宏观动脉硬化与供肾废弃独立相关（优势比[OR]，1.36；95%置信区间[CI]，1.02-1.80；P=0.03）。动脉硬化（任何程度）与移植后延迟肾功能不全（OR，1.16；95%CI，0.94-1.43；P=0.16）、移植后 1 年估算肾小球滤过率（B，0.58；95%CI，-2.07 至 3.22；P=0.67）和长期移植物存活率（HR，1.07；95%CI，0.86-1.33；P=0.55）无显著相关性。轻度动脉硬化与原发性无功能之间存在显著相关性（OR，2.14；95%CI，1.19-3.84；P=0.01）。我们没有发现宏观动脉硬化与组织学动脉硬化之间存在相关性，也没有发现组织学动脉硬化与移植结果之间存在相关性。
肾动脉宏观动脉硬化与供肾废弃独立相关，与移植后原发性无功能有些许相关。然而，动脉硬化对移植后延迟肾功能不全、1 年时估算肾小球滤过率或长期移植物存活率没有影响。我们的研究结果仅在排除平均动脉硬化程度较高的废弃肾脏后仍然有效。因此，应根据这种潜在的偏倚来解释研究结果。
