移植前组织学评分与灌注后老年供肾受者 6 个月时肾小球滤过率相关：一项初步研究结果。

Preimplantation Histological Score Associates with 6-Month GFR in Recipients of Perfused, Older Kidney Grafts: Results from a Pilot Study.

机构信息

Department of Renal Medicine, Clinical Research Centre for Rare Diseases "Aldo e Cele Daccò": Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy.

Unit of Nephrology and Dialysis, Azienda Socio-Sanitaria Territoriale (ASST) Papa Giovanni XXIII, Bergamo, Italy.

出版信息

Nephron. 2021;145(2):137-149. doi: 10.1159/000512341. Epub 2021 Jan 22.

DOI:10.1159/000512341

PMID:33486477

Abstract

BACKGROUND

Biopsy-guided selection of older kidneys safely expands the organ pool, and pretransplant perfusion improves the preservation of these fragile organs. Herein, we studied morphofunctional variables associated with graft outcomes in perfused, histologically evaluated older kidneys.

METHODS

This single-center prospective cohort pilot study evaluated the relationships between preimplantation histologic scores and renal perfusion parameters during hypothermic, pulsatile, machine perfusion (MP) and assessed whether these morphofunctional parameters associated with GFR (iohexol plasma clearance) at 6 months after transplantation in 20 consecutive consenting recipients of a biopsy-guided single or dual kidney transplant from >60-year-old deceased donors.

RESULTS

The donor and recipient age was 70.4 ± 6.5 and 63.6 ± 7.9 years (p = 0.005), respectively. The kidney donor profile index (KDPI) was 93.3 ± 8.4% (>80% in 19 cases), histologic score 4.4 ± 1.4, and median (IQR) cold ischemia time 19.8 (17.8-22.8 h; >24 h in 5 cases). The 6-month GFR was 41.2 (34.9-55.7) mL/min. Vascular resistances positively correlated with global histologic score (p = 0.018) at MP start and then decreased from 0.88 ± 0.43 to 0.36 ± 0.13 mm Hg/mL/min (p < 0.001) in parallel with a three-fold renal flow increase from 24.0 ± 14.7 to 74.7 ± 31.8 mL/min (p < 0.001). Consistently, vascular resistance reductions positively correlated with global histologic score (p = 0.009, r = -0.429). Unlike KDPI or vascular resistances, histologic score was independently associated with 6-month GFR (beta standardized coefficient: -0.894, p = 0.005).

CONCLUSIONS

MP safely improves graft perfusion, particularly in kidneys with severe histologic changes that would not be considered for transplantation because of high KDPI. The preimplantation histologic score associates with the functional recovery of older kidneys even in the context of a standardized program of pulsatile perfusion.

摘要

背景

活检指导下选择老年肾脏可以安全地扩大器官库，移植前的灌注可以更好地保存这些脆弱的器官。在此，我们研究了与灌注后老年供肾移植结果相关的形态功能变量，这些供肾经过组织学评估。

方法

本单中心前瞻性队列研究评估了低温、搏动、机器灌注（MP）期间移植前组织学评分与肾灌注参数之间的关系，并评估了这些形态功能参数与 20 例连续接受活检指导的>60 岁老年死亡供者的单或双肾移植后 6 个月时 GFR（碘海醇血浆清除率）的相关性。

结果

供者和受者的年龄分别为 70.4 ± 6.5 岁和 63.6 ± 7.9 岁（p = 0.005）。肾供者情况指数（KDPI）为 93.3 ± 8.4%（19 例>80%），组织学评分为 4.4 ± 1.4，中位（IQR）冷缺血时间为 19.8（17.8-22.8 h；5 例>24 h）。6 个月时的 GFR 为 41.2（34.9-55.7）mL/min。血管阻力与 MP 开始时的整体组织学评分呈正相关（p = 0.018），随后从 0.88 ± 0.43 降至 0.36 ± 0.13 mm Hg/mL/min（p < 0.001），同时肾血流量增加了三倍，从 24.0 ± 14.7 增加到 74.7 ± 31.8 mL/min（p < 0.001）。同样，血管阻力降低与整体组织学评分呈正相关（p = 0.009，r = -0.429）。与 KDPI 或血管阻力不同，组织学评分与 6 个月时的 GFR 独立相关（标准化系数：-0.894，p = 0.005）。