Prognostic utility of preimplantation kidney biopsy from deceased older donors in first year post-transplant renal function

详细信息    查看全文

• 作者：Juan J. Amená ; bar^a ; ^{juanjose.amenabariribar@osakidetza.eus" class="auth_mail" title="E-mail the corresponding author} ; Jhon A. Camacho^a ; Nerea Gó ; mez-Larrambe^a ; Teresa Visus^a ; José ; I. Pijoan^b ; Jaime Gonzá ; lez del Tá ; nago^c ; Sofí ; a Zá ; rraga^a ; Jorge Garcí ; a-Olaverri^d ; Francisco J. Gaí ; nza^a
• 关键词：Older deceased donor ; Expanded criteria donor ; Preimplantation kidney biopsy ; Kidney transplantation ; Glomerular filtration rate
• 刊名：Nefrología (English Edition)
• 出版年：2016
• 出版时间：January-February 2016
• 年：2016
• 卷：36
• 期：1
• 页码：33-41
• 全文大小：626 K

文摘

Preimplantation renal biopsy provides potentially valuable information about post-transplant renal function.

Objective

To assess the prognostic value of preimplantation kidney biopsy from older donors in determining 1-year post-transplant estimated glomerular filtration rate MDRD-4 (eGFR).

Methods

We evaluated a cohort of 124 renal transplant recipients from deceased donors ≥60 years old, performed at our centre between March 2008 and May 2012. Biopsies were assessed by applying the score proposed by O’Valle et al. The overall score was stratified into 3 levels: 0–3, 4–5 and 6–8 points. Kidneys scoring >8 points were discarded. A total of 77% of the donors were ≥70 years.

Results

One year post-transplant, mean eGFR (SD) was lower in transplant recipients with 6–8 points (38.5 [14.1] ml/min/1.73 m²) than in the group scoring 4–5 points (46.3 [15.7] [p = 0.03]) and the group scoring 0–3 (49.6 [12.5] [p = 0.04]). Seven patients (19%) had eGFR <30 ml/min/1.73 m² 1 year post-transplant in group 6–8 vs 8 (14%) in group 4–5 and none in group 0–3. In the logistic regression, OR (95% IC), to determine patients with 1-year post-transplant eGFR (<30 ml/min/1.73 m²), delayed graft function (6.3 [1.9–21.3]) and acute rejection (5.8 [1.1–31]), were significant. The adjusted OR of biopsy score group 6–8 vs 0–5, was 2.2 (0.7–7.3).

Conclusions

Allografts with higher pathologic score in preimplantation renal biopsy were associated with a worse 1-year post-transplant eGFR. Delayed graft function and acute rejection were significant risk factors for 1-year post-transplant low eGFR.