Barreda Paloma, Miñambres Eduardo, Ballesteros María Ángeles, Mazón Jaime, Gómez-Román Javier, Gómez Ortega José María, Belmar Lara, Valero Rosalía, Ruiz Juan Carlos, Rodrigo Emilio
From the Nephrology Department/Transplantation and Autoimmunity Groupt, University Hospital Marqués de Valdecilla/IDIVAL, University of Cantabria, Cantabria, Spain.
Exp Clin Transplant. 2022 Dec;20(12):1069-1075. doi: 10.6002/ect.2022.0171.
The number of kidney transplants obtained from controlled donations after circulatory death is increasing, with long-term outcomes similar to those obtained with donations after brain death. Extraction using normothermic regional perfusion can improve results with controlled donors after circulatory death; however, information on the histological impact and extraction procedure is scarce.
We retrospectively investigated all kidney transplants performed from October 2014 to December 2019, in which a follow-up kidney biopsy had been performed at 1-year follow-up, comparing controlled procedures with donors after circulatory death and normothermic regional perfusion versus donors after brain death. Interstitial fibrosis/tubular atrophy was assessed by adding the values of interstitial fibrosis and tubular atrophy, according to the Banff classification of renal allograft pathology.
When we compared histological data from 66 transplants with donations after brain death versus 24 transplants with donations after circulatory death and normothermic regional perfusion, no differences were found in the degree of fibrosis in the 1-year follow-up biopsy (1.7 ± 1.3 vs 1.7 ± 1.1; P = .971) or in the ratio of patients with increased fibrosis calculated as interstitial fibrosis/tubular atrophy >2 (18% vs 13%; P = .522). In our multivariate analysis, which included acute rejection, expanded criteria donation, and the type of donation, no variable was independently related to an increased risk of interstitial fibrosis/tubular atrophy >2.
The outcomes of kidney grafts procured in our center using controlled procedures with donors after circulatory death and normothermic regional perfusion were indistinguishable from those obtained from donors after brain death, showing the same degree of fibrosis in the 1-year posttransplant surveillance biopsy. Our data support the conclusion that normothermic regional perfusion should be the method of choice for extraction in donors after circulatory death.
来自心脏死亡后捐赠的可控供肾移植数量正在增加，其长期结果与脑死亡后捐赠的结果相似。采用常温区域灌注进行摘取可改善心脏死亡后可控供肾的移植结果；然而，关于组织学影响和摘取程序的信息却很匮乏。
我们回顾性研究了2014年10月至2019年12月期间进行的所有肾移植手术，这些手术在1年随访时均进行了随访肾活检，比较了心脏死亡后捐赠并采用常温区域灌注的可控摘取程序与脑死亡后捐赠的情况。根据肾移植病理的班夫分类，通过将间质纤维化和肾小管萎缩的值相加来评估间质纤维化/肾小管萎缩情况。
当我们比较66例脑死亡后捐赠的移植组织学数据与24例心脏死亡后捐赠并采用常温区域灌注的移植组织学数据时，在1年随访活检中的纤维化程度（1.7±1.3对1.7±1.1；P = 0.971）或纤维化增加患者的比例（间质纤维化/肾小管萎缩>2计算得出）方面未发现差异（18%对13%；P = 0.522）。在我们的多变量分析中，包括急性排斥反应、扩大标准供体和捐赠类型，没有变量与间质纤维化/肾小管萎缩>2的风险增加独立相关。
我们中心采用心脏死亡后捐赠并进行常温区域灌注的可控程序获取的肾移植结果与脑死亡后捐赠的结果无差异，在移植后1年的监测活检中显示出相同程度的纤维化。我们的数据支持这样的结论，即常温区域灌注应成为心脏死亡后捐赠者摘取肾脏的首选方法。
