Baseline Vascular Pathology in Deceased Donor Kidneys: Differential Impact on Transplant Outcomes by Donor Type

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2025-09-26 DOI:10.1111/ctr.70332

Junichiro Sageshima, Naeem Goussous, Yvonne Kelly, Caitlin Loseth, Karima Alghannam, Ling-Xin Chen, Lea Matsuoka, Sophoclis Alexopoulos, Richard Perez, Kuang-Yu Jen

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Abstract

Background

The impact of kidney vascular pathology on transplant outcomes remains poorly understood, particularly under specific donor conditions.

Methods

This retrospective single-center study analyzed 837 deceased donor kidney transplants. Based on baseline vascular histology, the kidneys were categorized into two groups: minimal vascular disease (Group 0, n = 637) and significant vascular disease (Group 1, n = 200). Five-year graft survival and 6- and 12-month kidney function were evaluated, along with subgroup analyses of various donor characteristics. Propensity score matching was used to adjust for confounding factors.

Results

Recipients of kidneys with significant vascular disease showed worse 5-year overall graft survival (64.6% vs. 80.0%, p = 0.0002) and death-censored graft survival (85.6% vs. 91.5%, p = 0.0126). These differences persisted after propensity score matching. The impact was most pronounced in hypertensive donors (53.4% vs. 84.9%) and diabetic donors (52.3% vs. 69.0%). Circulatory death donors showed immediate adverse effects, while brain death donors demonstrated delayed deterioration. Kidneys with significant vascular disease exhibited lower glomerular filtration rates at follow-up.

Conclusion

Baseline vascular disease in deceased donor kidneys has a significant impact on transplant outcomes, independent of clinical risk factors. These findings support the incorporation of vascular histological assessment into donor evaluation to enhance risk stratification and optimize post-transplant management.

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死亡供体肾脏的基线血管病理：供体类型对移植结果的不同影响

肾血管病理对移植结果的影响仍然知之甚少，特别是在特定的供体条件下。方法回顾性分析837例死亡肾移植供体。根据基线血管组织学，将肾脏分为两组：最小血管病变（0组，n = 637）和显著血管病变（1组，n = 200）。评估5年移植物存活率、6个月和12个月肾功能，并对各种供体特征进行亚组分析。倾向评分匹配用于调整混杂因素。结果有明显血管疾病的肾脏受者的5年总移植存活率（64.6% vs. 80.0%, p = 0.0002）和死亡切除移植存活率（85.6% vs. 91.5%, p = 0.0126）较差。这些差异在倾向评分匹配后仍然存在。高血压供者（53.4% vs. 84.9%）和糖尿病供者（52.3% vs. 69.0%）的影响最为明显。循环性死亡供者表现出立即的不良反应，而脑死亡供者表现出延迟的恶化。有明显血管疾病的肾脏在随访中表现出较低的肾小球滤过率。结论死亡供肾的基线血管疾病对移植结果有显著影响，独立于临床危险因素。这些发现支持将血管组织学评估纳入供体评估，以加强风险分层和优化移植后管理。

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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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.