Nephrology, Dialysis and Renal Transplant Unit, IRCCS - Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 9, 40138, Bologna, Italy.
Alma Mater Studiorum, University of Bologna, 40138, Bologna, Italy.
Int Urol Nephrol. 2023 Oct;55(10):2611-2619. doi: 10.1007/s11255-023-03552-x. Epub 2023 Mar 20.
Diabetic donors are recognized as a reliable source of organs, although the discard rate of kidneys is still high. Few data are available on the histological evolution of these organs especially on kidneys transplanted into non-diabetic patients who remain euglycemic.
We describe the histological evolution of ten kidney biopsies performed on non-diabetic recipients of diabetic donors.
Mean donor age was 69 ± 7 years, 60% were males. Two donors were treated with insulin, eight with oral antidiabetic drugs. Mean recipient age was 59.9 ± 7 years, 70% were males. The pre-existing diabetic lesions identified in the pre-implantation biopsies, encompassed all histological classes, and were associated with mild IF/TA and vascular damages. The median follow-up was 59.5 [IQR 32.5-99.0] months; at follow-up, 40% of cases did not change histologic classification, two patients with class IIb downgraded to IIa or I and one with class III downgraded to IIb. Conversely, three cases showed a worsening, from class 0 to I, I to IIb or from IIa to IIb. We also observed a moderate evolution of IF/TA and vascular damages. At follow-up visit, estimated GFR was stable (50.7 mL/min vs. 54.8 at baseline) and proteinuria was mild (51.1 ± 78.6 mg/day).
Kidneys from diabetic donors show variable evolution of the histologic features of diabetic nephropathy after transplant. This variability may be associated to recipients characteristics such as euglycemic milieu, in case of improvement, or obesity and hypertension, in case of worsening of histologic lesions.
糖尿病供体被认为是器官的可靠来源，尽管其肾脏的废弃率仍然很高。有关这些器官的组织学演变，特别是在移植到血糖正常的非糖尿病患者的肾脏方面，数据很少。
我们描述了 10 例非糖尿病糖尿病供体受者的肾活检的组织学演变。
供体平均年龄为 69±7 岁，60%为男性。2 例供者接受胰岛素治疗，8 例接受口服降糖药物治疗。受体平均年龄为 59.9±7 岁，70%为男性。在移植前活检中发现的预先存在的糖尿病病变，涵盖了所有的组织学类型，并伴有轻度 IF/TA 和血管损伤。中位随访时间为 59.5[IQR 32.5-99.0]个月；在随访时，40%的病例组织学分类没有改变，2 例 IIb 级病例降级为 IIa 级或 I 级，1 例 III 级病例降级为 IIb 级。相反，有 3 例病例出现恶化，从 0 级到 I 级，从 I 级到 IIb 级，或从 IIa 级到 IIb 级。我们还观察到 IF/TA 和血管损伤的中度演变。在随访时，估计的肾小球滤过率（eGFR）稳定（50.7mL/min 与基线时的 54.8mL/min），蛋白尿轻度（51.1±78.6mg/天）。
糖尿病供体的肾脏在移植后糖尿病肾病的组织学特征表现出不同的演变。这种可变性可能与受者的特征有关，如改善时的血糖正常环境，或恶化时的肥胖和高血压。
