供肾零点活检在活体肾移植中的应用价值

The application value of time-zero renal biopsy in living donor kidney transplantation

目的目前关于供肾零点活检在活体供肾移植中的研究甚少。文中旨在探讨活体供肾零点活检出现潜在病理改变的影响因素及其对术后早期移植肾功能的预测价值。方法回顾性分析2008年1月至2016年12月于南京军区南京总医院国家肾脏疾病临床医学研究中心进行的89例活体肾移植供者及89例受者临床资料。取其供肾零点活检标本。依据2007版Banff版标准,对供肾潜在的肾小球硬化、肾小管萎缩、间质纤维化、小动脉透明样变性及动脉纤维内膜增厚等5项常见病理改变进行评分,分析不同病理改变发生的影响因素;并对相应受者术后1、3、6个月,探讨不同病理改变对于受者术后早期移植肾功能的预测价值。结果 89例活体供肾零点活检标本中,23例(25.84%)存在肾小球硬化改变(其中轻度21例、中度1例、重度1例),33例(37.08%)存在肾小管萎缩/间质纤维化改变(其中轻度30例、中度3例),37例(41.57%)存在动脉内膜透明样变性/动脉纤维内膜增厚改变(其中轻度36例、中度1例)。肾小球硬化改变与供者年龄相关(P=0.042),肾小管/间质改变与供者年龄、性别及收缩压水平相关(P=0.019、0.006、0.01);动脉改变与供者性别及血三酰甘油水平相关(P=0.029、0.049)。供肾出现肾小球硬化的受者术后3个月、6个月移植肾肾小球滤过率[(65.96±17.17)、(69.52±19.1)m L/(min·1.73m2)]均低于无肾小球硬化改变的受者[(76.91±18.98)、(79.52±18.91)m L/(min·1.73m2)],差异有统计学意义(P<0.05)。结论活体供肾零点活检结果对于术后6月内移植肾功能具有预测价值,可指导受者术后免疫抑制方案的制定与调整;此外,还可发现供者潜在肾病,是制定供者术后个性化随访方案的依据之一,具有临床实用性。

Objective Few studies have paid attention to time-zero renal biopsy in living kidney transplantation so far. This article aimed to investigate the risk factors of latent pathologic changes in living donors by time-zero renal biopsy（TO-RBx） and the predictive value in the allograft function of recipients early after living kidney transplantation. Methods We retrospectively analysed the clinical data of 89 renal transplant recipients and living donors who received TO-RBx at Nanjing General Hospital from January 2008 to December 2016. According to the 2007 Banff criteria,the common pathologic changes in living donors such as latent glomeruloscerosis（GS）,tubular atrophy（CT）,interstitial fibrosis（CI）,arteriolar hyaline thickening（AH） and vascular fibrous intimal thickening（CV） were scored. To analyze the influencing factors for different pathological changes and evaluate its predictive value in the allograft function of recipients in 1,3,6 months after living renal transplantation. Results Of all the TO-RBx specimens,23 cases（25.84%） with GS（21 were mild change,1 was moderate change and 1 was severe change）,33 cases（37.08%） with CT/CI changes（30 were mild change and 3 were moderate change） and 37 cases（41.57%） with AH/CV changes（36 were mild change and 1 was moderate change）. GS was related to the donor age（P = 0.042）; CT/CI changes were related to donor age,gender and systolic pressure（P = 0.019; 0.006; 0.01）; arterial changes were related to donor gender and blood triglyceride level（P = 0.029; 0.049）. Within 3 and 6 months after living donor renal transplantation,the e GFR of renal transplant recipients with GS lesions [（65.96± 17.17）,（69.52±19.1） m L/min·1.73 m^2]were significantly lower than the groups without lesions [（76.91±18.98）,（79.52±18.91） m L/min·1.73 m^2]（P〈0.05）. Conclusion Time-zero renal biopsy has significance in terms of predicting the allograft function in 6 months after transplantation. It can guide the formulation and adjustment of postoperative immunosuppressive regimens for recipients. Besides,it can also detect the latent pathologic changes in living donors and is one of the important evidence for establishing a personalized follow-up plan for donors after surgery. This method is practical in clinical.