Division of Nephrology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
UFRGS Medical School, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
Transpl Int. 2022 Mar 24;35:10344. doi: 10.3389/ti.2022.10344. eCollection 2022.
Delayed graft function (DGF) is a common complication of kidney transplantation and frequently leads to the necessity of surveillance biopsies. The purpose of this study is to describe the histological findings in surveillance biopsies of deceased donor kidney transplant recipients and evaluate the risk factors for graft outcomes. This is a monocentric, retrospective study including kidney transplant recipients that underwent a graft biopsy during the DGF period between January 2006 and July 2019. 356 biopsies were performed in 335 deceased donor transplant recipients. Biopsies were analyzed according to the Banff classification. The main histological findings were: acute tubular necrosis in 150 biopsies (42.1%), acute rejection in 96 biopsies (26.9%), and borderline findings in 91 biopsies (25.5%). In the multivariate analysis, recipient age ( = 0.028) and DGF duration ( = 0.005) were associated with rejection, antibody-induction with anti-thymocyte globulin (ATG) was protective ( = 0.001). The occurrence of rejection was associated with lower death-censored graft survival (log-rank; = 0.009). Surveillance biopsies of kidney grafts experiencing DGF remain an essential tool for the care of kidney transplant recipients. The recipient's age and duration of DGF are independent risk factors for acute rejection, while antibody-induction therapy with ATG is associated with protection from its occurrence.
延迟移植物功能（DGF）是肾移植的常见并发症，经常需要进行监测活检。本研究的目的是描述接受尸体供肾移植受者 DGF 期间监测活检的组织学发现，并评估移植物结局的危险因素。这是一项单中心回顾性研究，纳入了 2006 年 1 月至 2019 年 7 月期间 DGF 期间接受移植肾活检的肾移植受者。在 335 名接受尸体供肾移植的受者中进行了 356 次活检。根据 Banff 分类对活检进行分析。主要的组织学发现是：150 次活检中出现急性肾小管坏死（42.1%），96 次活检中出现急性排斥反应（26.9%），91 次活检中出现边界性发现（25.5%）。多变量分析显示，受者年龄（ = 0.028）和 DGF 持续时间（ = 0.005）与排斥反应相关，抗胸腺细胞球蛋白（ATG）诱导抗体具有保护作用（ = 0.001）。排斥反应的发生与死亡风险校正移植物存活率降低相关（对数秩检验； = 0.009）。经历 DGF 的肾移植物监测活检仍然是肾移植受者护理的重要工具。受者年龄和 DGF 持续时间是急性排斥反应的独立危险因素，而 ATG 诱导抗体治疗与排斥反应的发生保护相关。
