高血压脑出血供者供肾评估及肾移植预后分析

Evaluations of kidney from hypertensive cerebral hemorrhage donor and prognosis of renal transplantation

目的应用Remuzzi评分系统评估高血压脑出血供者供肾与脑外伤公民逝世后器官捐献供者供肾的组织病变程度,并探讨高血压脑出血供者供肾在肾移植受者中的预后。方法选取山西省第二人民医院2016年1月1日至2018年6月1日的肾移植受者,根据供肾的来源分为两组,高血压脑出血致心脏死亡者(高血压脑出血组),脑外伤致心脏死亡者(脑外伤组),供者符合中国二类或三类标准。供肾获取后移植术前行病理活检,行苏木素-伊红染色后,采用Remuzzi评分系统评估供肾组织病变程度。两组供肾均采用低温机器灌注保存。两组的免疫抑制方案相同。比较两组肾移植受者的预后,包括肾移植受者术后1、6、12个月血清肌酐水平及12~36个月移植肾累计存活率。结果高血压脑出血供者的肾脏Remuzzi评分显著高于脑外伤供者,最大肌酐清除率为(86.8±27.8)ml/min,显著低于脑外伤供者的(115.4±23.2)ml/min(P<0.05)。肾移植术后1、6、12个月,脑外伤组血肌酐水平分别为(76.1±18.5)μmol/L、(72.4±16.2)μmol/L、(71.4±16.8)μmol/L,均低于高血压脑出血组的(160.3±33.4)μmol/L、(154.3±32.6)μmol/L、(146.4±29.1)μmol/L(P<0.05)。随访12~36个月,Kaplan-meier分析结果表明高血压脑出血组与脑外伤组移植肾存活率差异无统计学意义(Log-Rank检验,P=0.485)。结论高血压脑出血供者供肾短期内存活率与脑外伤供肾差异无统计学意义。高血压脑出血供肾的肾移植术后血肌酐水平高于脑外伤供肾。选择性地采用高血压脑出血致心脏死亡的供者供肾移植,可以极大地减少供肾的浪费,改善终末期肾病患者的生活质量。

Objective Remuzzi scoring system is utilized for assessing the degree of renal tissue damage in donors with hypertensive cerebral hemorrhage and donors with brain trauma after cardiac death.To explore the prognosis of hypertensive cerebral hemorrhage donor kidney in renal transplant recipients.Methods The kidney donated by DCD between January 1,2016 to June 1,2018 were retrospectively reviewed.Pathological biopsy was performed before transplantation and hematoxylin-eosin(HE)staining after sectioning.The degree of renal tissue lesions was evaluated by Remuzzi scoring system.According to the source of donor kidney,they were divided into two groups of donors with heart failure due to hypertensive cerebral hemorrhage(HCH)and those with brain trauma(BT).Both groups of donor kidneys were preserved by low-temperature machine perfusion.The immunosuppressive regimen was identical in both groups.The prognosis of two groups was compared by serum creatinine(Scr)at Month 1/6/12 post-operation and cumulative graft survival rate over a follow-up period of 12-36 months.Results The renal Remuzzi score of HCH donors was significantly higher than that of BT donors.The maximal creatinine clearance rate was significantly lower than that of BT donors[(86.8±27.8)vs(115.4±23.2)ml/min,P<0.05].At 1/6/12 months post-transplantation,serum creatinine levels were(76.1±18.5),(72.4±16.2)and(71.4±16.8)μmol/L in BT group and(160.3±33.4),(154.3±32.6)and(146.4±29.1)μmol/L in HCH group.The SCr in BT group at 1/6/12 months was lower than that in HCH group(P<0.05).Kaplan-meier analysis showed no significant inter-group difference in graft survival between two groups over a follow-up period of 12 to 36 months(Log-Rank test,P=0.485).Conclusions No significant difference exists in short-term survival rate of kidneys from HCH and BT donors.The recipients of HCH donor's kidney have higher serum creatinine levels than those of BT donors.Selective use of kidney transplants in patients with cardiac death caused by HCH may greatly reduce the waste of donor kidney and improve the quality-of-life of patients with end-stage renal disease.