合并急性肾损伤供者供肾零点活检评估及移植后临床效果分析

Evaluation with time-zero biopsy in donors with acute kidney function injury and clinical effect after transplantation

目的探讨器官捐献供者合并急性肾损伤(AKI)的情况下,对供肾穿刺零点活检评估及移植后临床效果分析。方法回顾性分析2019年5月至2020年5月郑州大学第一附属医院104例供者的零点活检评估的病理资料,根据AKI的定义及Banff2016标准,对104例供者的供肾进行分组并评估供肾是否进行移植,分析比较不同程度病理改变的供肾移植后肌肾功能[肌酐和估算的肾小球滤过率(eGFR)]的差异和急性肾小管损伤的程度。结果104例供者中32例发生了AKI,与未发生AKI的供者相比,其病理表现在肾间质纤维化和急性肾小管损伤的程度上差异有统计学意义(P<0.05),其他病理表现程度差异无统计学意义(P>0.05)。AKI供者中,Banff>3分的2例供者的供肾均弃用,非AKI供者中,Banff>3分的供者12例,1例供者供肾因慢性病变程度高弃用,Banff≤3分的1例供者的右肾因缺血硬化萎缩弃用,最终三组受者进行比较,AKI组受者在术后1年的肌酐值和eGFR与非AKI组Banff≤3分受者的差异无统计学意义(P>0.05),均优于非AKI组Banff≤3分受者(P<0.05)。AKI组受者术后DGF发生率较高,持续时间长,其他并发症比较上差异无统计学意义(P>0.05)。结论病理表现为中度肾小管损伤以下且Banff评分<3分的AKI供肾可行移植,尽管移植后肾功能恢复较慢,但其移植后仍可获得安全的移植效果。

Objective To evaluate the time-zero biopsy of donor kidney with acute kidney injury(AKI)in organ donation donors and examine the clinical effect after transplantation.Methods From May 2019 to May 2020,clinical data were retrospectively reviewed for 104 donors assessed by time-zero biopsy at First Affiliated Hospital,Zhengzhou University.According to the definition of AKI and Banff2016 criteria,the kidneys of 104 donors were grouped and evaluated for transplantation.And the post-transplantation effects of donor kidneys with different degrees of pathological changes were analyzed.Results AKI occurred in 32/104 donors.Compared with non-AKI donors,statistically significant differences existed in degrees of renal interstitial fibrosis and acute renal tubular injury(P<0.05).However,there were no significant differences in other pathological manifestations(P>0.05).In AKI group,kidneys of 2 donors with Banff score>3 were abandoned;in non-AKI group,among 12 donors with Banff score>3,1 donor kidney was abandoned due to a high degree of chronic diseases.No significant inter-group difference existed in creatinine value or estimated glomerular filtration rate(eGFR)(P>0.05).AKI group had a higher incidence of postoperative delayed graft function(DGF)and longer duration.There was no statistical significance in other complications(P>0.05).Conclusions AKI donor kidneys with pathological manifestations below moderate renal tubular injury and Banff score<3 are feasible for transplantation.Although renal function recovery is slow after transplantation,safe outcomes may be obtained.