探讨供肾零点活检病理结果与肾移植术后并发移植肾功能延迟恢复(DGF)的关系。

回顾性分析西安交通大学第一附属医院肾移植科2018年5月至2019年4月实施的心脏死亡器官捐献(DCD)肾移植供、受者临床资料。采用零点活检病理结果评估供肾质量，并按照Banff 2013标准、Remuzzi评分及马里兰病理指数(MAPI)对供肾进行病理分级和评分。肾小球数量≥7个，小动脉数量≥2支为合格标本。根据受者肾移植术后是否发生DGF，将其分为DGF组和非DGF组。采用Mann-Whitney U检验比较两组供肾肾小球硬化率、小动脉玻璃样变率、Banff 2013标准评分、Remuzzi评分和MAPI评分。采用卡方检验比较两组供肾肾间质纤维化、肾小管萎缩、小动脉内膜纤维化增厚、小动脉管壁透明样变、肾小管损伤/坏死及肾小球内微血栓发生情况。采用logistic回归分析供肾零点活检病理结果与DCD肾移植术后并发DGF的关系。P<0.05为差异有统计学意义。

最终纳入133例受者，其中DGF组26例，DGF发生率为19.5%，非DGF组107例。133例合格肾穿刺标本中，平均获得肾小球数量(13±5)个，中位肾小球硬化率5.8%(0～13.3%)，中位小动脉数量5支(3～6支)，中位小动脉玻璃样变率0(0～11%)，肾间质纤维化占47.4%(63/133)，肾小管萎缩占48.1%(64/133)，小动脉内膜纤维化增厚占58.6%(78/133)，小动脉管壁透明样变占36.8%(49/133)，未见肾小球内微血栓，所有供肾均合并不同程度肾小管损伤/坏死。两组受者供肾肾间质纤维化、肾小管萎缩、肾小管损伤/坏死以及Remuzzi评分差异有统计学意义(χ²＝7.65、7.92和16.81，Z＝-2.02，P均<0.05)。多因素分析结果显示肾小管损伤/坏死是肾移植术后并发DGF的独立危险因素。

供肾零点活检病理学评估对于预测肾移植短期预后具有一定价值，在供者维护和器官保存过程中应尽可能避免造成肾小管缺血/坏死，以降低DGF发生风险。

To analyze the correlation between allograft zero-time biopsy results and kidney transplant recipients with delayed graft function (DGF) after transplantation.

The clinical data of kidney transplant recipients and donors in the Institute of Kidney Transplantation, the First Affiliated Hospital, Medical College of Xi′an Jiaotong University from May 2018 to April 2019 were retrospectively analysed, all the donors were donation after cardiac death (DCD). Zero-time biopsy was used to assess the quality of donor kidneys. Banff 2013 criteria, Remuzzi score and Maryland aggregate pathology index (MAPI) were used to assess the pathology grades and scores in the pre-transplant biopsy. Eligible samples were defined as >7 glomerulus and >2 arterioles. According to the occurrence of DGF, the kidney transplant recipients were divided into DGF group and non-DGF group. Mann-Whitney U test was used to compare glomerulus sclerosis rate, arteriole hyalinosis rate, Banff 2013 criteria scores, Remuzzi scores and MAPI scores between the 2 groups. Chi-square test was utilized to compare renal interstitial fibrosis, tubular atrophy, thickening of the arteriole wall, hyaline degeneration of arteriole, renal tubule injury/necrosis and microthrombus in glomerulus between the 2 groups. Logistic regression model was used to analyze the correlation between allograft zero-time biopsy results and DGF of transplant kidney.

133 recipients were enrolled in this study, 26(19.5%) recipients developed DGF (DGF group). There were 107 recipients in non-DGF group. Among the eligible samples of donor kidneys, the average amount of glomeruli were (13±5), the median glomerulus sclerosis rate was 5.8%(0-13.3%), the median amount of arterioles were 5(3-6), the median hyaline degeneration rate of arteriole was 0(0-11%), 47.4%(63/133) of the kidneys had interstitial fibrosis, 48.1%(64/133) of the kidneys had tubular atrophy, 58.6%(78/133) of the kidneys had arterial intimal fibrosis thickening, 36.8%(49/133) of the kidneys had hyaline degeneration in the arterial wall, none of the kidneys had glomerular micro thrombosis, all kidneys had various renal tubule injury/necrosis. The renal interstitial fibrosis, tubular atrophy, renal tubule injury/necrosis and Remuzzi scores between the 2 groups had significant difference (χ²=7.65, 7.92 and 16.81, Z=-2.02, all P<0.05). Multivariate logistic regression model shown that renal tubule injury/necrosis was an independent risk factor of DGF in kidney transplant recipients.

Pre-implantation pathological assessment provide some guidance in predicting short-term transplantation outcome. We should try to avoid the factors that induce renal tubule injury/necrosis in the procedure of donor maintenance and organ harvesting for decreasing the occurrence risk of DGF.