移植前活检Remuzzi高评分供肾移植的临床观察

Clinical study on kidney allograft transplantation from marginal donors with high pathological Remuzzi score in preimplantation biopsy

目的初步观察Remuzzi评分高的器官捐献供肾移植给成人受者的近期效果。方法回顾性分析2019年1月至2019年12月间华中科技大学同济医学院附属同济医院接受了移植前活检Remuzzi评分4分及以上心死亡器官捐献供者供肾移植的受者31例,分为双肾移植组(DKT组,14例)和单肾移植组(SKT组,17例)。Remuzzi平均评分为DKT组左肾5.05/右肾5.26,SKT组左肾4.92/右肾4.58。双供肾植入受者同侧髂窝。统计术后1年内的受者/肾存活情况、肾功能状况及急性排斥反应、移植肾功能延迟(DGF)和蛋白尿等并发症情况。结果DKT组和SKT组的受者男性占比分别为92.9%比52.9%,体重指数分别为(23.93±2.56)kg/m2比(21.09±2.85)kg/m2,两组间差异有统计学意义(P<0.05)。DKT组1例术后11个月移植肾功能丧失,移植肾1年存活率92.9%,受者存活率100%,SKT组受者/移植肾1年存活率均为100%。术后12个月的血肌酐(SCr),DKT组为(164±37.7)μmol/L,SKT组(154.92±96.2)μmol/L,两组间差异无统计学意义(P>0.05);估算的肾小球滤过率(eGFR),术后12个月时DKT组为(41.84±9.01)ml/(min·1.73m2),SKT组(44.8±18.16)ml/(min·1.73m2),差异无统计学意义(P>0.05)。两组术后未见严重外科并发症,各有1例急性排斥反应,予甲泼尼龙冲击治疗后逆转;两组的DGF发生率(DKT组42.9%比SKT组41.2%)和蛋白尿发生率(DKT组57.1%比SKT组41.2%)差异无统计学意义(P>0.05)。结论移植前活检Remuzzi≥4分的高评分供肾,通过分配施行双肾移植或者基于供、受者匹配的单肾移植,可以取得良好的近期受者/移植肾存活效果,长期效果待随访观察。

Objective To explore the outcome of kidney transplantation from donation after cadaveric death(DCD)with high pathological Remuzzi score.Methods From January,2019 to December,2019,31 recipients of kidney allograft transplantation from marginal donors with Remuzzi score≥4 in preimplantation biopsy were retrospectively enrolled.They were divided into two groups of dual kidney transplantation(DKT,14 cases)and single kidney transplantation(SKT,17 cases).Median Remuzzi score of left kidney(5.05 in DKT group vs 4.92 in SKT group)or right kidney(5.26 vs.4.58)was comparable.Dual donor kidneys were implanted into ipsilateral iliac fossa.Survival outcomes,kidney function,acute rejection episodes,incidence of delayed graft function(DGF)and proteinuria were recorded within Year 1 post-operation.Results Proportion of male(92.9%vs.52.9%,P<0.05)and recipient's body mass index(BMI,23.93 vs.21.09)were significant higher in DKT group than those in SKT group.One graft failure occurred in DKT group at Month 11 post-operation.The 1-year graft survival rate was 92.9%in DKT group and 1-year recipient survival rate both 100%in two groups.Mean 12-month serum creatinine[SCr,(164±37.7)μmol/L vs.(154.92±96.2)μmol/L]and estimated glomerular filtration rate[eGFR,(41.84±9.01)vs.(44.8±18.16)ml/(min·1.73m2)]were comparable between two groups(both P>0.05).There was no occurrence of thrombosis resulting in graft loss.One-year incidence of acute rejection,rate of DGF(42.9%vs 41.2%)and proteinuria(57.1%vs.41.2%)were comparable between two groups(both P>0.05).Conclusions Through donor-recipient matching and dual kidney transplant allocation,short-term survival outcome of kidney allograft from marginal donors with high Remuzzi score≥4 is encouraging.However,long-term outcomes should be further examined.