供肾移植前活检的慢性病变程度对移植后肾功能和存活的影响

Effect of chronic lesions in implantation biopsy on the function and survival of renal grafts from cardiac death donors

目的探讨供肾移植前活检的慢性病变程度对肾移植术后移植肾功能和存活的影响。方法回顾性分析2011年7月至2014年12月完成的71例公民逝世后器官捐献（DCD）供者供肾移植前活检资料及供、受者临床资料，其中“中国二类”供者14例和“中国三类”供者57例，供者死亡原因分别为脑外伤25例，脑血管疾病38例，脑肿瘤2例，以及缺血缺氧性脑病6例。计算供者供肾的肾小球硬化（GS）比例和Remuzzi评分，评估GS比例和Remuzzi评分对移植肾功能和存活的影响。结果肾穿刺活检41例，肾小球数量为（23．7±9．6）个（2条穿刺组织）；肾楔形切取活检30例，肾小球数量为（37．2±16．7）个。术后1年时，GS≤20％组受者的估算肾小球滤过率（eGFR）为（72．9±22．6）ml／min，显著高于GS〉20％组的（48．9±18．9）ml／min（P〈0．001）；Remuzzi评分0～3分组受者的eGFR为（76．3±21．4）ml／min，显著高于4～5分组受者的（44．0±10．9）ml／min（P〈0．001）。随访14-40个月，Kaplan-Meier分析结果表明，GS≤20％组和GS〉20％组移植肾存活率的差异无统计学意义（P〉0．05），Remuzzi0～3分组和4～5分组移植肾存活率的差异亦无统计学意义（P〉0．05）。结论移植前活检存在严重慢性病变[GS〉20％和（或）Remuzzi评分4～5分]的供肾，其移植后移植肾的功能较差，但移植后近期（1年内）存活良好。

Objective To explore the effect of chronic lesions in implantation biopsy on the function and survival of renal grafts from donation after cardiac death （DCD） donors. Methods Preimplant kidney biopsy from DCD donors from July 2011 to December 2014 was retrospectively reviewed. There were 71 cases of DCD donors including 14 cases of China Category Ⅱ and 57 eases of China Category Ⅲ. The causes of death were brain trauma （n = 25）, eerebrovaseular accident （n = 38）, brain tumor （n = 2）, and anoxia （n = 6）. The rate of glomorulosclerosis （GS） and Remuzzi score of the kidneys were calculated and the effects of GS and Remuzzi score on the renal graft function and survival time were evaluated. Results Needle biopsies were performed on 41 cases with glomeruli 23. 7 ± 9. 6 （2 strips）, and wedge biopsies were performed on 30 cases with glomeruli 37. 2 ± 16. 7. The 12- month estimated glomerular filtration rate （eGFR） of renal grafts with GS 0-20% was significantly higher than grafts with GS〉20% （72. 9± 22. 6 mL/min vs. 48. 9 ± 18. 9 mL/min, P〈0. 001）, and eGFR of renal grafts with Remuzzi score 0-3 was significantly higher than grafts with Remuzzi score 4- 5 （76. 3 ± 21.4 mL/min vs. 44. 0 ± 10. 9 mL/min, P〈0. 001）. During a follow-up period of 14-40 months, Kaplan-Meier analysis showed that there were no statistical differences in graft survival between kidneys with GS 0-20% and GS〉20%, and between kidneys with Remuzzi score 0-3 and 4-5. Conclusion Kidneys from DCD donors with severe chronic lesions （GS 〉20% or Remuzzi score 4-5） have poor graft function at one year after transplantation but with excellent short-term graft survival.