目的:一些活体供肾在植入时发现有慢性瘢痕和/或肾小球疾病的活检证据,但目前尚不清楚这些活检结果是否有助于预测供肾恢复或同种异体移植结局.我们的目的是确定慢性组织学改变和肾小球疾病在供体肾脏的患病率,以及它们与捐赠者和接受者结果的关联。
方法:回顾性队列研究。
方法:单中心,2010年1月至2022年7月的活体肾脏移植。
方法:慢性组织学改变,供体肾脏植入活检中的肾小球疾病。
结果:(a)对于捐赠者,单肾eGFR增加,总eGFR损失百分比,eGFR从捐赠前基线下降≥40%,捐赠后6个月的eGFR<60ml/min/1.73m2;(b)对于接受者,死亡审查的同种异体移植物存活。
方法:根据肾小球硬化的百分比,根据病理学家诊断,活检被分类为可能患有肾小球疾病或慢性变化。间质纤维化/肾小管萎缩,血管疾病。我们使用逻辑回归来确定与慢性变化相关的因素,线性回归,以确定慢性变化和单肾估计肾小球滤过率(eGFR)恢复之间的关系,和事件发生时间分析,以确定异常活检结果与同种异体移植结局之间的关系。
结果:在1104个活体供体肾脏中,155例(14%)植入活检有晚期慢性改变,和12(1%)的发现提示可能的供体肾小球疾病。调整后的逻辑回归显示,年龄(每10年OR2.44,95CI1.98-3.01),西班牙裔种族(OR1.87,95CI1.15-3.05),和高血压(OR1.92,95CI1.01-3.64),与植入活检慢性改变的几率较高相关。调整线性回归显示,晚期慢性改变与单肾eGFR增加或eGFR<60ml/min/1.73ml的相对风险无关。当比较具有慢性变化的肾脏与没有组织学异常的肾脏时,在未调整或调整的Cox比例风险模型中,死亡时间审查的同种异体移植失败没有差异。
结论:回顾性,没有测量的GFR。
结论:大约1/7的活体供肾在植入活检中有慢性改变,主要以中度血管疾病的形式,1%有可能的供体肾小球疾病。异常植入活检结果与6个月供者eGFR结果或同种异体移植物存活率无显著相关。
Some living donor kidneys are found to have biopsy evidence of chronic scarring and/or glomerular disease at implantation, but it is unclear if these biopsy findings help predict donor kidney recovery or allograft outcomes. Our objective was to identify the prevalence of chronic histological changes and glomerular disease in donor kidneys, and their association with donor and recipient outcomes.
Retrospective cohort study.
Single center, living donor kidney transplants from January 2010 to July 2022.
Chronic histological changes, glomerular disease in donor kidney implantation biopsies.
For donors, single-kidney estimated glomerular filtration rate (eGFR) increase, percent total eGFR loss, ≥40% eGFR decline from predonation baseline, and eGFR<60mL/min/1.73m2 at 6 months after donation; for recipients, death-censored allograft survival.
Biopsies were classified as having possible glomerular disease by pathologist diagnosis or chronic changes based on the percentage of glomerulosclerosis, interstitial fibrosis/tubular atrophy, and vascular disease. We used logistic regression to identify factors associated with the presence of chronic changes, linear regression to identify the association between chronic changes and single-kidney estimated glomerular filtration rate (eGFR) recovery, and time-to-event analyses to identify the relationship between abnormal biopsy findings and allograft outcomes.
Among 1,104 living donor kidneys, 155 (14%) had advanced chronic changes on implantation biopsy, and 12 (1%) had findings suggestive of possible donor glomerular disease. Adjusted logistic regression showed that age (odds ratio [OR], 2.44 per 10 years [95% CI, 1.98-3.01), Hispanic ethnicity (OR, 1.87 [95% CI, 1.15-3.05), and hypertension (OR, 1.92 [95% CI, 1.01-3.64), were associated with higher odds of chronic changes on implantation biopsy. Adjusted linear regression showed no association of advanced chronic changes with single-kidney eGFR increase or relative risk of eGFR<60mL/min/1.73m2. There were no differences in time-to-death-censored allograft failure in unadjusted or adjusted Cox proportional hazards models when comparing kidneys with chronic changes to kidneys without histological abnormalities.
Retrospective, absence of measured GFR.
Approximately 1 in 7 living donor kidneys had chronic changes on implantation biopsy, primarily in the form of moderate vascular disease, and 1% had possible donor glomerular disease. Abnormal implantation biopsy findings were not significantly associated with 6-month donor eGFR outcomes or allograft survival.
Kidney biopsies are the gold standard test to identify the presence or absence of kidney disease. However, kidneys donated by healthy living donors-who are extensively screened for any evidence of kidney disease before donation-occasionally show findings that might be considered \"abnormal,\" including the presence of scarring in the kidney or findings suggestive of a primary kidney disease. We studied the frequency of abnormal kidney biopsy findings among living donors at our center. We found that about 14% of kidneys had chronic abnormalities and 1% had findings suggesting possible glomerular kidney disease, but the presence of abnormal biopsy findings was not associated with worse outcomes for the donors or their recipients.