Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan.
Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan.
Transplant Proc. 2021 Dec;53(10):2833-2840. doi: 10.1016/j.transproceed.2021.09.018. Epub 2021 Oct 28.
Preservation of remnant renal function (RRF) is one of the major concerns among living kidney donors (LKDs). A comprehensive assessment is needed to predict the RRF. In this prospective study, we investigated the roles of histologic findings from a 1-hour allograft biopsy in predicting the RRF.
Our prospective study included 116 LKDs who underwent donor nephrectomy (DN) at our institute. Clinical and radiographic data were obtained from their medical charts. Renal volume parameters were calculated using the preoperative computed tomographic images in the volume analyzer SYNAPSE VINCENT image analysis system. Tissues obtained from allograft biopsy were examined. RRF was defined as the estimated glomerular filtration rate (eGFR) 12 months after DN.
Of 116 LKDs, 95 were finally evaluated. The median age of the LKDs at DN and the preoperative eGFR were 57 years and 80.0 mL/min/1.73 m, respectively. In the histologic analysis, 68 allografts (71.6%) had nonspecific findings involving the glomerulus, vessel, and tubulointerstitium. Interstitial fibrosis or tubular atrophy (IF/TA) was the only significant predictive factor for RRF (P = .039). No significant association was found between renal volume parameters and IF/TA, whereas remnant renal volume adjusted by body weight (RRV/BW) tended to be relatively correlated with IF/TA (P = .072). Furthermore, LKDs with subclinical IF/TA tended to have decreased RRV/BW compared with those without subclinical IF/TA (P = .088).
Our findings suggested that the presence of IF/TA could be a predictive factor for RRF after DN. Further research establishing the predictive model for RRF is warranted to improve the outcomes of LKDs.
保留残余肾功能（RRF）是活体供肾者（LKD）关注的主要问题之一。需要进行全面评估以预测 RRF。在这项前瞻性研究中，我们研究了 1 小时同种异体移植活检的组织学发现对 RRF 的预测作用。
我们的前瞻性研究包括在我们研究所接受供肾切除术（DN）的 116 名 LKD。从他们的病历中获得临床和影像学数据。使用术前 CT 图像在 SYNAPSE VINCENT 图像分析系统中的体积分析器中计算肾脏体积参数。检查从同种异体移植活检中获得的组织。RRF 定义为 DN 后 12 个月的估计肾小球滤过率（eGFR）。
在 116 名 LKD 中，最终评估了 95 名。DN 时 LKD 的中位年龄和术前 eGFR 分别为 57 岁和 80.0 mL/min/1.73 m。在组织学分析中，68 个同种异体移植物（71.6％）具有涉及肾小球，血管和肾小管间质的非特异性发现。间质纤维化或肾小管萎缩（IF/TA）是 RRF 的唯一显著预测因素（P=0.039）。没有发现肾脏体积参数与 IF/TA 之间存在显著关联，而通过体重调整的残余肾体积（RRV/BW）与 IF/TA 呈正相关（P=0.072）。此外，与无亚临床 IF/TA 的 LKD 相比，具有亚临床 IF/TA 的 LKD 倾向于具有较小的 RRV/BW（P=0.088）。
我们的发现表明，IF/TA 的存在可能是 DN 后 RRF 的预测因素。需要进一步研究建立 RRF 的预测模型，以改善 LKD 的结果。
