Riad Samy M, Issa Naim, Denic Aleksandar, Kline Timothy L, Gregory Adriana V, Augustine Joshua, Al Ammary Fawaz, Luehrs Tony C, Mullan Aidan F, Rule Andrew D
Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.
Am J Transplant. 2025 Jul;25(7):1432-1442. doi: 10.1016/j.ajt.2025.01.041. Epub 2025 Jan 30.
This study aimed to identify the parenchymal structural features by both computed tomography (CT) and histology that are associated with death-censored graft failure in recipients of living donor kidneys. We analyzed kidney recipients of ABO-compatible living donor kidneys from 2000-2020 with follow-up through 2023. Cortical volume and thickness, individual medullary pyramid volume and count, glomerular volume, nephrosclerosis, and nephron number were assessed by deep learning models applied to the predonation CT and by morphometric histology analysis from the biopsy at the time of transplantation. There were 3098 recipients followed for a median of 5 years with 346 graft failure events. In adjusted analyses, the only structural measures associated with graft failure were fewer medullary pyramids on CT and a higher fraction of interstitial fibrosis and tubular atrophy on histology. Having ≤15 pyramids donated occurred in 9% and was associated with a graft failure incidence of 2.5 per 100 person-years compared to 1.6 per 100 person-years in the 17% with ≥26 pyramids donated. Fewer medullary pyramids were associated with a lower 1-year estimated glomerular filtration rate, which mediated the subsequent risk of graft failure. Interstitial fibrosis and tubular atrophy >1% is also associated with graft failure. Medullary pyramid count is a potentially useful predonation prognostic biomarker for graft failure in transplant recipients.
本研究旨在通过计算机断层扫描（CT）和组织学确定与活体供肾受者死亡截尾移植肾失功相关的实质结构特征。我们分析了2000年至2020年接受ABO血型相容活体供肾的肾移植受者，并随访至2023年。应用深度学习模型对捐献前CT进行分析，并通过移植时活检的形态计量组织学分析来评估皮质体积和厚度、单个髓质锥体体积和数量、肾小球体积、肾硬化和肾单位数量。共有3098名受者，中位随访时间为5年，发生346次移植肾失功事件。在多因素分析中，与移植肾失功相关的唯一结构指标是CT上髓质锥体数量较少，以及组织学上间质纤维化和肾小管萎缩比例较高。捐献的髓质锥体≤15个的情况占9%，其移植肾失功发生率为每100人年2.5次，而捐献的髓质锥体≥26个的占17%，其移植肾失功发生率为每100人年1.6次。髓质锥体数量较少与1年估计肾小球滤过率较低相关，这介导了随后的移植肾失功风险。间质纤维化和肾小管萎缩>1%也与移植肾失功相关。髓质锥体数量是移植受者移植肾失功的一个潜在有用的捐献前预后生物标志物。
