公民逝世后捐献肾脏的质量评估

doi:10.3877/cma.j.issn.1674-3903.2017.02.003

准确评估公民逝世后捐献肾脏的质量，可以避免供肾浪费，减少术后移植肾功能延迟恢复或移植肾原发性无功能的发生。目前临床通常对供肾进行肉眼大体观察、供者危险评分，有选择性地进行供肾活检，并结合肾脏低温机械灌注参数，以及供者血液、尿液和灌注液的分子诊断和生物标志物检测结果进行综合判定。尽管有多种评估技术，但仍无法精确评估供肾质量。当前，我国公民逝世后器官捐献案例正在快速增长中，亟待制订统一的标准来指导全国捐献器官的质量评估，推动其在临床上更规范、有效、安全地应用。

关键词: 器官捐献, 肾脏, 质量, 移植肾功能延迟恢复, 评估, 生物标志物

Accurate assessment of the kidney from donation after citizen′s death, can avoid the waste of the donor kidney, reduce the incidence of postoperative delayed graft function or renal allograft primary nonfunction. Naturally, donor kidney will be examined through visual observation, donor risk score, selective renal biopsy, parameters of hypothermic machine pefusion, as well as comprehensive judgement on molecular diagnosis, and biomarker detection for blood, urine and perfusion solution. However, accurate quality assessment of donor kidney has get to be improved. At present, organ donation after citizen′s death in China is growing rapidly. It is very necessary to formulate unified quality assessment standards to guide the national organ donation, and promote the more standardized, effective and safe clinical application.

Key words: Organ donation, Kidney, Quality, Delayed graft function, Assessment, Biomarker

表1 Pirani评分标准

肾小球硬化
?	0＝无肾小球硬化
?	1＝肾小球硬化比例<20%
?	2＝肾小球硬化比例20%～50%
?	3＝肾小球硬化比例>50%
肾小管萎缩
?	0＝无
?	1＝肾小管萎缩比例<20%
?	2＝肾小管萎缩比例20%～50%
?	3＝肾小管萎缩比例>50%
间质纤维化
?	0＝无
?	1＝肾组织被纤维结缔组织所替代的比例<20%
?	2＝肾组织被纤维结缔组织所替代的比例20%～50%
?	3＝肾组织被纤维结缔组织所替代的比例>50%
动脉和小动脉狭窄(若动脉病变局限，则以最明显的病变等级给予评分)
?	0＝无
?	1＝血管壁增厚，但厚度小于管腔直径
?	2＝血管壁增厚，但厚度等于或略大于管腔直径
?	3＝血管壁增厚，但厚度明显大于管腔直径伴明显管腔狭窄或闭塞
最终评分(0～12)
?	0～3　轻微病变，适于单肾移植
?	4～6中度病变，适于双肾移植
?	7～12严重病变，不能用于移植

表1 Pirani评分标准

肾小球硬化
?	0＝无肾小球硬化
?	1＝肾小球硬化比例<20%
?	2＝肾小球硬化比例20%～50%
?	3＝肾小球硬化比例>50%
肾小管萎缩
?	0＝无
?	1＝肾小管萎缩比例<20%
?	2＝肾小管萎缩比例20%～50%
?	3＝肾小管萎缩比例>50%
间质纤维化
?	0＝无
?	1＝肾组织被纤维结缔组织所替代的比例<20%
?	2＝肾组织被纤维结缔组织所替代的比例20%～50%
?	3＝肾组织被纤维结缔组织所替代的比例>50%
动脉和小动脉狭窄(若动脉病变局限，则以最明显的病变等级给予评分)
?	0＝无
?	1＝血管壁增厚，但厚度小于管腔直径
?	2＝血管壁增厚，但厚度等于或略大于管腔直径
?	3＝血管壁增厚，但厚度明显大于管腔直径伴明显管腔狭窄或闭塞
最终评分(0～12)
?	0～3　轻微病变，适于单肾移植
?	4～6中度病变，适于双肾移植
?	7～12严重病变，不能用于移植

表2 马里兰综合病理指数评分标准

病理特征
?	任何小动脉透明变性＝4分
?	任何球旁纤维化＝4分
?	任何疤痕＝3分
?	肾小球硬化>15%＝2分
?	小叶间动脉管壁与管腔之比≥0.5＝2分
最终评分
?	≤7分　移植肾5年生存率90%(低危组)
?	8～11分移植肾5年生存率63%(中危组)
?	12～15分移植肾5年生存率53%(高危组)

表2 马里兰综合病理指数评分标准

病理特征
?	任何小动脉透明变性＝4分
?	任何球旁纤维化＝4分
?	任何疤痕＝3分
?	肾小球硬化>15%＝2分
?	小叶间动脉管壁与管腔之比≥0.5＝2分
最终评分
?	≤7分　移植肾5年生存率90%(低危组)
?	8～11分移植肾5年生存率63%(中危组)
?	12～15分移植肾5年生存率53%(高危组)

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Assessment of the kidney from donation after citizen′s death

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Assessment of the kidney from donation after citizen′s death