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)

1	中华医学会器官移植学分会, 中华医学会外科学分会移植学组, 中国医师协会器官移植医师分会. 中国心脏死亡捐献器官评估与应用专家共识[J/CD]. 中华移植杂志：电子版, 2014, 8(3): 117-122.
2	Sung RS,Christensen LL,Leichtman AB, et al. Determinants of discard of expanded criteria donor kidneys: impact of biopsy and machine perfusion[J]. Am J Transplant, 2008, 8(4): 783-792.
3	Snoeijs MG,Buurman WA,Christiaans MH, et al. Histological assessment of preimplantation biopsies may improve selection of kidneys from old donors after cardiac death[J]. Am J Transplant, 2008, 8(9): 1844-1851.
4	Shapiro R,Halloran PF,Delmonico FL, et al. The "two, one, zero" decision: what to do with suboptimal deceased donor kidneys[J]. Am J Transpl, 2010, 10(9): 1959-1960.
5	聂峰,杨建均,黄志成, 等. 心脏死亡器官捐献供肾零点活检与受者程序性活检的临床分析[J/CD]. 中华移植杂志：电子版, 2014, 8(3): 128-132.
6	Lopes JA,Moreso F,Riera L, et al. Evaluation of pre-implantation kidney biopsies: comparison of Banff criteria to a morphometric approach[J]. Kidney Int, 2005, 67(4): 1595-1600.
7	Cockfield SM,Moore RB,Todd G, et al. The prognostic utility of deceased donor implantation biopsy in determining function and graft survival after kidney transplantation[J]. Transplantation, 2010, 89(5): 559-566.
8	Anglicheau D,Loupy A,Lefaucheur C, et al. A simple clinico-histopathological composite scoring system is highly predictive of graft outcomes in marginal donors[J]. Am J Transplant, 2008, 8(11): 2325-2334.
9	Summers DM,Johnson RJ,Allen J, et al. Analysis of factors that affect outcome after transplantation of kidneys donated after cardiac death in the UK: a cohort study[J]. Lancet, 2010, 376(9749): 1303-1311.
10	薛武军. 公民逝世后器官捐献供肾评估方法及改善的研究进展[J]. 器官移植, 2015, 6(3): 131-133.
11	Remuzzi G,Cravedi P,Perna A, et al. Long-term outcome of renal transplantation from older donors[J]. N Engl J Med, 2006, 354(4): 343-352.
12	Munivenkatappa RB,Schweitzer EJ,Papadimitriou JC, et al. The Maryland aggregate pathology index: a deceased donor kidney biopsy scoring system for predicting graft failure[J]. Am J Transplant, 2008, 8(11): 2316-2324.
13	Kahu J,Kyllönen L,Räisänen-Sokolowski A, et al. Donor risk score and baseline biopsy CADI value predict kidney allograft outcome[J]. Clin Transplant, 2011, 25(3): E276-E283.
14	Re L,Cicora F,Petroni J, et al. Comparison between clinical and histopathological scoring in cadaveric kidney transplantation and its correlation with posttransplant evolution[J]. Transplant Proc, 2006, 38(3): 903-904.
15	Muruve NA,Steinbecker KM,Luger AM. Are wedge biopsies of cadaveric kidneys obtained at procurement reliable？[J]. Transplantation, 2000, 69(11): 2384-2388.
16	Randhawa P. Role of donor kidney biopsies in renal transplantation[J]. Transplantation, 2001, 71(10): 1361-1365.
17	Carter JT,Chan S,Roberts JP, et al. Expanded criteria donor kidney allocation: marked decrease in cold ischemia and delayed graft function at a single center[J]. Am J Transplant, 2005, 5(11): 2745-2753.
18	Cecka JM,Gritsch HA. Why are nearly half of expanded criteria donor (ECD) kidneys not transplanted？[J]. Am J Transplant, 2008, 8(4): 735-736.
19	Nyberg SL,Matas AJ,Kremers WK, et al. Improved scoring system to assess adult donors for cadaver renal transplantation[J]. Am J Transplant, 2003, 3(6): 715-721.
20	Schold JD,Kaplan B,Baliga RS, et al. The broad spectrum of quality in deceased donor kidneys[J]. Am J Transplant, 2005, 5(4 Pt 1): 757-765.
21	Rao PS,Schaubel DE,Guiding MK, et al. A comprehensive risk quantification score for deceased donor kidneys: the kidney donor risk index[J]. Transplantation, 2009, 88(2): 231-236.
22	Watson CJ,Johnson RJ,Birch R, et al. A simplified donor risk index for predicting outcome after deceased donor kidney transplantation[J]. Transplantation, 2012, 93(3): 314-318.
23	Irish WD,McCollum DA,Tesi RJ, et al. Nomogram for predicting the likelihood of delayed graft function in adult cadaveric renal transplant recipients[J]. J Am Soc Nephrol, 2003, 14(11): 2 967-2 974.
24	Ojo AO. Influence of reporting methods of outcomes across transplant centers[J]. Clin J Am Soc Nephrol, 2012, 6(12): 2 732-2 734.
25	Jochmans I,Moers C,Smits JM, et al. Machine perfusion versus cold storage for the preservation of kidneys donated after cardiac death: a multicenter, randomized, controlled trial[J]. Ann Surg, 2010, 252(5): 756-764.
26	de Vries EE,Hoogland ER,Winkens B, et al. Renovascular resistance of machine-perfused DCD kidneys is associated with primary nonfunction[J]. Am J Transplant, 2011, 11(12): 2 685-2 691.
27	Bhangoo RS,Hall IE,Reese PP, et al. Deceased-donor kidney perfusate and urine biomarkers for kidney allograft outcomes: a systematic review[J]. Nephrol Dial Transplant, 2012, 27(8): 3 305-3 314.
28	Moers C,Varnav OC,van Heurn E, et al. The value of machine perfusion perfusate biomarkers for predicting kidney transplant outcome[J]. Transplantation, 2010, 90(9): 966-973.
29	Hollmen ME,Kyllönen LE,Inkinen KA, et al. Deceased donor neutrophil gelatinase-associated lipocalin and delayed graft function after kidney transplantation: a prospective study[J]. Crit Care, 2011, 15(3): R121.
30	Devarajan P. Review: neutrophil gelatinase-associated lipocalin: a troponin-like biomarker for human acute kidney injury[J]. Nephrology(Carlton), 2010, 15(4): 419-428.
31	Hosgood SA,Nicholson ML. First in man renal transplantation after ex-vivo normothermic perfusion[J]. Transplantation, 2011, 92(7): 735-738.

[1]	罗辉, 方晔. 品管圈在提高甲状腺结节细针穿刺检出率中的应用[J/OL]. 中华医学超声杂志（电子版）, 2024, 21(10): 972-977.
[2]	郝玥萦, 毛盈譞, 张羽, 汪佳旭, 韩林霖, 匡雯雯, 孟瑶, 杨秀华. 超声引导衰减参数成像评估肝脂肪变性及其对心血管疾病风险的预测价值[J/OL]. 中华医学超声杂志（电子版）, 2024, 21(08): 770-777.
[3]	王益佳, 周青, 曹省, 袁芳洁, 周妍, 张梅. 中国经胸超声心动图检查存图及报告质控现状分析[J/OL]. 中华医学超声杂志（电子版）, 2024, 21(07): 657-663.
[4]	周易, 张红梅, 尹立雪, 杨浩, 付培. 四川省超声医学质量控制指标动态变化趋势分析[J/OL]. 中华医学超声杂志（电子版）, 2024, 21(07): 664-670.
[5]	顾莉莉, 姜凡. 安徽省超声产前筛查切面图像质量现状调查情况及分析[J/OL]. 中华医学超声杂志（电子版）, 2024, 21(07): 671-674.
[6]	王晓娜, 张宁, 宋伟, 杨明, 李丽, 薛红元. 河北省超声医学质量管理与控制现状分析[J/OL]. 中华医学超声杂志（电子版）, 2024, 21(07): 675-680.
[7]	张亚庆, 黄旴宁, 许珊珊, 刘小蓝. 海南省二级与三级医院超声医学质量控制指标分析[J/OL]. 中华医学超声杂志（电子版）, 2024, 21(07): 681-685.
[8]	刘畅, 蒋洁, 胥雪冬, 崔立刚, 王淑敏, 陈文. 北京市海淀区医疗机构甲状腺超声检查及TIRADS分类基线调查[J/OL]. 中华医学超声杂志（电子版）, 2024, 21(07): 693-697.
[9]	吴禾禾, 马春亮, 常青, 陈宇, 牛丽娟, 王勇. 超声医学质量控制与住院医师规范化培训相结合的实践探讨[J/OL]. 中华医学超声杂志（电子版）, 2024, 21(07): 698-701.
[10]	杨桂清, 孟静静. 哺乳期亚临床乳腺炎的研究进展[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(06): 376-379.
[11]	吴警, 吐尔洪江·吐逊, 温浩. 肝切除术前肝功能评估新进展[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 889-893.
[12]	周学锋, 董哲毅, 冯哲, 蔡广研, 陈香美. 糖尿病肾脏疾病中西医结合诊疗指南计划书[J/OL]. 中华肾病研究电子杂志, 2024, 13(06): 301-305.
[13]	程柏凯, 杨光. 高胰岛素-正葡萄糖钳夹技术评估慢性肾脏病患者胰岛素抵抗的研究进展[J/OL]. 中华肾病研究电子杂志, 2024, 13(06): 334-339.
[14]	陈秀梅, 陈思涓, 郑小静. 护理联盟体构建及实践的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(08): 703-708.
[15]	白杰, 王唯一, 陈超, 王帆, 肖新如. 神经外科住培医师职业倦怠及影响因素研究[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 662-670.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Assessment of the kidney from donation after citizen′s death

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Assessment of the kidney from donation after citizen′s death