Université de Paris, Institut National de la Santé et de la Recherche Médicale U970, Paris Translational Research Centre for Organ Transplantation, Paris, France.
Renal-Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
J Am Soc Nephrol. 2021 Feb;32(2):397-409. doi: 10.1681/ASN.2020040464. Epub 2020 Dec 15.
Many kidneys donated for transplant in the United States are discarded because of abnormal histology. Whether histology adds incremental value beyond usual donor attributes in assessing allograft quality is unknown.
This population-based study included patients who received a deceased donor kidney that had been biopsied before implantation according to a prespecified protocol in France and Belgium, where preimplantation biopsy findings are generally not used for decision making in the allocation process. We also studied kidneys that had been acquired from deceased United States donors for transplantation that were biopsied during allocation and discarded because of low organ quality. Using donor and recipient characteristics, we fit multivariable Cox models for death-censored graft failure and examined whether predictive accuracy (C index) improved after adding donor histology. We matched the discarded United States kidneys to similar kidneys transplanted in Europe and calculated predicted allograft survival.
In the development cohort of 1629 kidney recipients at two French centers, adding donor histology to the model did not significantly improve prediction of long-term allograft failure. Analyses using an external validation cohort from two Belgian centers confirmed the lack of improved accuracy from adding histology. About 45% of 1103 United States kidneys discarded because of histologic findings could be accurately matched to very similar kidneys that had been transplanted in France; these discarded kidneys would be expected to have allograft survival of 93.1% at 1 year, 80.7% at 5 years, and 68.9% at 10 years.
In this multicenter study, donor kidney histology assessment during allocation did not provide substantial incremental value in ascertaining organ quality. Many kidneys discarded on the basis of biopsy findings would likely benefit United States patients who are wait listed.
在美国，许多用于移植的肾脏因组织学异常而被丢弃。组织学在评估同种异体移植物质量方面是否优于通常的供体属性尚不清楚。
本研究为基于人群的研究，包括在法国和比利时，根据预设方案对接受供体肾脏移植的患者进行活检，这两个国家的供体在移植前的活检结果通常不会用于分配过程中的决策。我们还研究了在美国获取的用于移植的供体肾脏，这些肾脏在分配过程中进行了活检，并因器官质量低而被丢弃。我们使用供体和受者的特征，拟合多变量 Cox 模型以预测死亡风险校正后的移植物失败，并评估在添加供体组织学后预测准确性（C 指数）是否提高。我们将丢弃的美国肾脏与在欧洲移植的类似肾脏进行匹配，并计算预测移植物存活率。
在两个法国中心的 1629 例肾移植受者的开发队列中，将供体组织学添加到模型中并不能显著提高长期移植物失败的预测能力。对来自两个比利时中心的外部验证队列的分析证实，添加组织学并不能提高准确性。约 1103 例因组织学发现而丢弃的美国肾脏中，约有 45%可以准确匹配在法国移植的非常相似的肾脏；这些被丢弃的肾脏在 1 年、5 年和 10 年时的移植物存活率预计分别为 93.1%、80.7%和 68.9%。
在这项多中心研究中，分配期间的供体肾脏组织学评估并未在确定器官质量方面提供实质性的增量价值。许多基于活检结果丢弃的肾脏可能会使等待移植的美国患者受益。
