肾移植活组织切片病理结果对肾移植存活的意义

IF 0.3 Q4 TRANSPLANTATION International Journal of Organ Transplantation Medicine Pub Date : 2019-01-01 Epub Date: 2019-02-01
A V Trailin, T N Nykonenko, T I Ostapenko, S R Vildanov, O S Nykonenko
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引用次数: 0

摘要

背景:供体肾活检的单个组织学病变和综合评分与移植结果之间没有一致的联系:供肾活检中的单个组织学病变和综合评分与移植结果之间没有一致的联系:评估供体肾脏中哪些急性或慢性单个组织学病变和综合评分与受者的移植存活率有关:方法:我们研究了尸体肾脏(n=101)和活体肾脏(n=29)移植活组织切片中的单个组织学病变和8个综合评分系统与5年死亡校正移植物存活率的关系:我们发现供体肾脏中慢性病变的发生率很高,大部分与动脉硬化有关,与供体年龄的关系不大。移植后活检的急性、慢性和总Banff评分,移植前活检的慢性和总Banff评分,供体损伤评分和慢性损伤评分均可预测死亡校正后的移植物存活率。然而,在多变量模型中,只有慢性和总Banff评分有显著影响。移植前的慢性和移植后的总Banff评分显示出最高的曲线下面积(AUC),分别为0.722和0.717。在单个病变中,根据班夫分级标准评估的肾小球硬化≥20%、肾间质炎症>0、动脉硬化=3、动脉透明化>0和肾间质纤维化>0与较低的异体移植存活率相关。通过对这些病变的回归系数求和,我们建立了供体肾损伤指数(DKDI),其AUC为0.747。当与再移植、低温缺血时间和急性排斥反应相结合时,DKDI、移植前慢性和移植后 Banff 总分进一步提高了预测准确性,其 AUC 分别为 0.842、0.807 和 0.802:结论:DKDI、移植前慢性期和移植后总Banff评分单独使用或与临床变量结合使用可促进移植后的决策制定。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

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Significance of the Pathologic Findings in Implantation Biopsies for Kidney Allografts Survival.

Background: There is no consistent association between individual histological lesions and composite scores in donor kidney biopsy and transplant outcomes.

Objective: To evaluate which acute or chronic individual histological lesions and composite scores in donor kidney were associated with graft survival in the recipient.

Methods: We investigated the association of individual histological lesions and 8 composite scoring systems in implantation biopsies of cadaveric (n=101) and living (n=29) kidneys with 5-year death-censored graft survival.

Results: We found a high frequency of chronic lesions in donor kidneys, mostly associated with arteriosclerosis, and less dependent from donor age. Acute, chronic, and total Banff scores for post-transplant biopsies, chronic and total Banff scores for pre-implant biopsies, donor damage score and chronic damage score predicted death-censored graft loss. However, only chronic and total Banff-scores had significant effects in multivariate model. Chronic pre-implant and total post-transplant Banff scores demonstrated the highest area under the curve (AUC) of 0.722 and 0.717, respectively. Among individual lesions, glomerulosclerosis ≥20%, interstitial inflammation >0, arteriosclerosis =3, arteriolar hyalinosis >0, and interstitial fibrosis >0, assessed with Banff-grading criteria, were associated with lower allograft survival. We created the Donor Kidney Damage Index (DKDI), by summing regression coefficients for these lesions, which yielded the AUC of 0.747. When combined with retransplantation, cold ischemia time and acute rejection, DKDI, chronic pre-implant and total post-transplant Banff scores further improved their predictive accuracy, yielding AUCs of 0.842, 0.807, and 0.802, respectively.

Conclusion: DKDI, chronic pre-implant and total post-transplant Banff scores alone and combined with clinical variables may facilitate decision making in post-transplant period.

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来源期刊
CiteScore
1.60
自引率
0.00%
发文量
0
审稿时长
12 weeks
期刊介绍: The International Journal of Organ Transplantation Medicine (IJOTM) is a quarterly peer-reviewed English-language journal that publishes high-quality basic sciences and clinical research on transplantation. The scope of the journal includes organ and tissue donation, procurement and preservation; surgical techniques, innovations, and novelties in all aspects of transplantation; genomics and immunobiology; immunosuppressive drugs and pharmacology relevant to transplantation; graft survival and prevention of graft dysfunction and failure; clinical trials and population analyses in the field of transplantation; transplant complications; cell and tissue transplantation; infection; post-transplant malignancies; sociological and ethical issues and xenotransplantation.
期刊最新文献
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