Denic Aleksandar, Rule Andrew D, Gaillard François
Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.
Transplantation Department, Hospital Edouard Herriot, Lyon, France.
Clin Kidney J. 2021 Dec 11;15(5):841-844. doi: 10.1093/ckj/sfab267. eCollection 2022 May.
Since the first living donor kidney transplantation about six decades ago, significant progress has been made in terms of extending allograft survival. However, to date, only a small number of studies have compared the functional changes of the donated kidney to that of the remaining kidney. Although relatively small, the study by Gonzalez Rinne demonstrated the adaptive capacity of the transplanted kidney in 30 donor-recipient pairs. The glomerular filtration rate (GFR) in both donors and recipients was obtained 12 months after transplantation and the authors identified three scenarios: (i) where donors had a higher GFR than recipients; (ii) where donors had a lower GFR than recipients; and (iii) where donors had a similar GFR to recipients. The mechanisms mediating GFR adaptability after kidney transplantation seem to be associated with body surface area (including sex differences in body surface area). Microstructural analysis of human and animal models of renal physiology provides some clues to the physiological adaptation of the transplanted organ. The nephron number from endowment and age-related loss and the adaptive ability for compensatory glomerular hyperfiltration likely play a major role.
自大约六十年前首例活体供肾肾移植以来，在延长移植肾存活时间方面已取得显著进展。然而，迄今为止，只有少数研究比较了供肾与留存肾的功能变化。冈萨雷斯·林内的研究规模相对较小，但在30对供受者中证实了移植肾的适应能力。在移植后12个月测定了供者和受者的肾小球滤过率（GFR），作者确定了三种情况：（i）供者的GFR高于受者；（ii）供者的GFR低于受者；（iii）供者的GFR与受者相似。肾移植后介导GFR适应性的机制似乎与体表面积有关（包括体表面积的性别差异）。对人类和动物肾脏生理学模型的微观结构分析为移植器官的生理适应提供了一些线索。先天的肾单位数量、与年龄相关的肾单位丢失以及代偿性肾小球高滤过的适应能力可能起主要作用。
