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Abstract：
The utility of zero-time kidney biopsies (KB) in deciding to accept expanded criteria donor (ECD) kidneys remains controversial. However, zero-time histology is one of the main causes for discarding kidneys in the United States. In a single-centre study, we examined the utility and impact on outcome of the use of frozen section zero-time KB among ECD. Ninety-two zero-time KB were analysed for accept/discard decision between 2005 and 2015 among ECD. 53% of kidneys were rejected after zero-time KB analysis; there was no difference in individual clinical and biological data between accepted/rejected groups. However, histology of rejected kidneys showed more sclerotic glomeruli (20% vs. 8%; P < 0.001), increased interstitial fibrosis (1.25 ± 0.12 vs. 0.47 ± 0.09; P < 0.0001), more arteriosclerosis (2.14 ± 0.17 vs. 1.71 ± 0.11; P = 0.0032) and arteriolar hyalinosis (2.15 ± 0.12 vs. 1.55 ± 0.11; P = 0.0006). Using propensity score matching, we generated a group of 42 kidney allograft recipients who received a transplant matched for donor zero-time histology and clinical characteristics with donors whose kidneys were rejected. Interestingly, their 1- and 5-year graft survival and function were similar to the global cohort of ECD recipients. In conclusion, when performed, zero-time KB was a decisive element for kidney discard decision. However, adverse zero-time histology was not associated with poorer graft survival and kidney function among ECD.
摘要：
零时间肾脏活检（KB）在决定接受扩大标准供体（ECD）肾脏中的实用性仍存在争议。然而,在美国，零时组织学是丢弃肾脏的主要原因之一。在一项单中心研究中，我们研究了在ECD中使用冷冻切片零时KB的效用和对结果的影响。在2005年至2015年的ECD中，分析了92个零时间KB的接受/丢弃决定。在零时间KB分析后，53%的肾脏被拒绝；接受/拒绝组之间的个体临床和生物学数据没有差异。然而,排斥肾脏的组织学表现出更多的硬化性肾小球（20％vs.8%；P<0.001），间质纤维化增加（1.25±0.12vs.0.47±0.09;P<0.0001),更多动脉硬化(2.14±0.17vs.1.71±0.11；P=0.0032）和小动脉透明（2.15±0.12vs.1.55±0.11；P=0.0006）。使用倾向得分匹配，我们收集了一组42名同种异体肾移植受者,他们接受了供体零时组织学和临床特征与肾脏被排斥的供体相匹配的移植.有趣的是,他们的1年和5年移植物存活率和功能与ECD受者的全球队列相似.总之,执行时，零时KB是决定肾脏丢弃的决定性因素。然而,在ECD中,不良的零时组织学与移植物存活率和肾功能较差无关.
