移植前活检联合肾脏灌注运输器对移植肾近期预后的评价  

Short-term prognosis of kidney allograft evaluated by pre-implantation biopsy combined with Lifeport

作　　者：李雪 梁少姗 程东瑞 文吉秋 谢轲楠 倪雪峰 陈劲松 Li Xue;Liang Shaoshan;Cheng Dongrui;Wen Jiqiu;Xie Kenan;Ni Xuefeng;Chen Jinsong(National Clinical Research Center of Kidney Diseases,Jinling Hospital,Nanjing University,School of Medicine,Nanjing 210002,China)

机构地区：[1]南京大学医学院附属金陵医院(东部战区总医院)国家肾脏疾病临床医学研究中心,210002

出　　处：《中华器官移植杂志》2021年第5期287-292,共6页Chinese Journal of Organ Transplantation

基　　金：国家自然科学基金(81800629)。

摘　　要：目的:评价移植前活检联合肾脏灌注运输器(Lifeport)对移植肾近期预后的预测价值。方法:对2017年12月至2019年12月于东部战区总医院行肾移植手术的34例心脏死亡器官捐献(DCD)供者移植前活检组织病理学资料、Lifeport参数和受者术后3个月内的移植肾功能恢复情况进行分析,观察组织病理学指标和Lifeport参数与术后3个月估算的肾小球滤过率(eGFR)的关系和对移植肾功能延迟恢复(DGF)的预测价值。结果:术后发生DGF 13例,占38.2%。DGF组供肾获取时血肌酐以及Lifeport低温机械灌注(HMP)后0.5、1、2、4 h的阻力指数(RI)显著高于非DGF组,其中RI以HMP 4h时两组差异最显著。组织学方面,DGF组急性肾小管损伤(ATI)评分较非DGF组高,而Remuzzi评分两组间相比差异无统计学意义。移植术后3个月时的eGFR与HMP 4h时的RI以及Remuzzi评分之间具有相关性(RI:r=-0.48,P<0.001;Remuzzi评分:ρ=-0.42,P=0.01),而与ATI评分之间相关性没有统计学意义。另外,Lifeport HMP 4 h的RI联合ATI评分可以将预测DGF的敏感度提高至100%(95%CI:75.3%~100%),特异度提高至90.5%(95%CI:69.6%~98.8%)。结论:DGF组供肾获取时血肌酐、Lifeport RI以及ATI评分显著高于非DGF组,而移植术后3个月时的eGFR与Lifeport RI以及Remuzzi评分之间具有相关性;ATI评分与Lifeport灌注4 h的RI联合可以提高DGF的敏感度和特异度。Objective We aimed to evaluate the predictive value of pre-implantation biopsy combined with Lifeport for the short-term prognosis of kidney allograft from donation after citizen death(DCD).Methods Data from a total of 34 patients who had undergone kidney transplantation in Jinling Hospital from December 2017 to December 2019 were retrospectively analyzed.Histopathological data from pre-implantation biopsy,Lifeport parameters and recipient kidney transplant function at 3 months post-surgery were collected.The performances of histopathological indexes,and Lifeport parameters to predict delayed graft function(DGF)and estimated glomerular filtration rate(eGFR)at 3 months post-surgery were observed evaluated.Results 13 cases of DGF occurred,accounting for 38.2%.Serum creatinine at death and resistance index(RI)at 0.5 h,1 h,2 h and 4 h after Lifeport hypothermic machine perfusion(HMP)in the DGF group was significantly higher than that in the non-DGF group.Histologically,the acute tubular injury(ATI)score of the DGF group was higher than that of the non-DGF group,whereas the Remuzzi score was not statistically different between the two groups.The eGFR at 3 months post-transplant was moderately correlated with the RI at 4 h HMP and the Remuzzi score(RI:r=-0.48,P<0.001;Remuzzi score:ρ=-0.42,P=0.01),but no correlated with ATI score of the donor kidney.Although Remuzzi score was not correlated with kidney allograft recovery time(ρ=-0.25,P=0.16),it was inversely correlated with eGFR at 3 months post-transplant(ρ=-0.42,P=0.01).Combined use of Lifeport HMP 4-hour RI and ATI score increased the sensitivity and specificity of predicting DGF to 100%(95%CI:75.3%-100%)and 90.5%(95%CI:69.6%-98.8%)respectively.Conclusions The serum creatinine at death,Lifeport RI,and ATI score of the DGF group were significantly higher than those of the non-DGF group,and the eGFR at 3 months post-transplant was correlated with the Lifeport RI and Remuzzi score.Combined use of ATI score and RI at 4 hours of Lifeport perfusion improved the sensitiv

关 键 词：肾移植 病理组织学 供者 预后 

分 类 号：R699.2[医药卫生—泌尿科学]