高血压脑出血供者肾的评价及肾移植预后

Chineae Journal of Organ Transplantation Pub Date : 2019-10-20 DOI:10.3760/CMA.J.ISSN.0254-1785.2019.10.003

P. Sun, Haoyu Chen, Zhixiang Jia, Muqing Liu, Yan Qin, Yuan Dong, X. Hao, Huafeng Zhou

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Both groups of donor kidneys were preserved by low-temperature machine perfusion. The immunosuppressive regimen was identical in both groups. The prognosis of two groups was compared by serum creatinine (Scr) at Month 1/6/12 post-operation and cumulative graft survival rate over a follow-up period of 12-36 months. \n \n \nResults \nThe renal Remuzzi score of HCH donors was significantly higher than that of BT donors. The maximal creatinine clearance rate was significantly lower than that of BT donors [(86.8±27.8) vs (115.4±23.2) ml/min, P<0.05]. At 1/6/12 months post-transplantation, serum creatinine levels were (76.1±18.5), (72.4±16.2) and (71.4±16.8) μmol/L in BT group and (160.3±33.4), (154.3±32.6) and (146.4±29.1) μmol/L in HCH group. The SCr in BT group at 1/6/12 months was lower than that in HCH group (P<0.05). 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摘要

目的应用Remuzzi评分系统评价高血压脑出血供者和心源性死亡脑外伤供者肾组织损伤程度。探讨肾移植受者高血压脑出血供肾的预后。方法回顾性分析2016年1月1日至2018年6月1日通过DCD捐赠的肾脏。移植前行病理活检，切片后行苏木精伊红(HE)染色。采用Remuzzi评分系统评价肾组织病变程度。根据供肾来源分为高血压脑出血心力衰竭组(HCH)和脑外伤组(BT)。两组供肾均采用低温机器灌注保存。两组的免疫抑制方案相同。比较两组患者术后1/6/12个月血清肌酐(Scr)及12-36个月的累积移植物存活率的预后。结果HCH供者肾脏Remuzzi评分明显高于BT供者。最大肌酐清除率明显低于BT供者[(86.8±27.8)vs(115.4±23.2)ml/min, P<0.05]。移植后1/6 ~ 12个月，BT组血清肌酐水平分别为(76.1±18.5)、(72.4±16.2)、(71.4±16.8)μmol/L, HCH组分别为(160.3±33.4)、(154.3±32.6)、(146.4±29.1)μmol/L。1/6/12月时BT组SCr低于HCH组(P<0.05)。Kaplan-meier分析显示，在随访12 ~ 36个月期间，两组间移植物存活率无显著差异(Log-Rank检验，P=0.485)。结论HCH和BT供体肾脏短期存活率无显著差异。HCH供者肾脏受体血清肌酐水平高于BT供者。HCH所致心源性死亡患者选择性使用肾脏移植可大大减少供体肾脏的浪费，提高终末期肾病患者的生活质量。关键词:肾移植;高血压;预后

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Evaluations of kidney from hypertensive cerebral hemorrhage donor and prognosis of renal transplantation

Objective Remuzzi scoring system is utilized for assessing the degree of renal tissue damage in donors with hypertensive cerebral hemorrhage and donors with brain trauma after cardiac death. To explore the prognosis of hypertensive cerebral hemorrhage donor kidney in renal transplant recipients. Methods The kidney donated by DCD between January 1, 2016 to June 1, 2018 were retrospectively reviewed. Pathological biopsy was performed before transplantation and hematoxylin-eosin (HE) staining after sectioning. The degree of renal tissue lesions was evaluated by Remuzzi scoring system. According to the source of donor kidney, they were divided into two groups of donors with heart failure due to hypertensive cerebral hemorrhage (HCH) and those with brain trauma (BT). Both groups of donor kidneys were preserved by low-temperature machine perfusion. The immunosuppressive regimen was identical in both groups. The prognosis of two groups was compared by serum creatinine (Scr) at Month 1/6/12 post-operation and cumulative graft survival rate over a follow-up period of 12-36 months. Results The renal Remuzzi score of HCH donors was significantly higher than that of BT donors. The maximal creatinine clearance rate was significantly lower than that of BT donors [(86.8±27.8) vs (115.4±23.2) ml/min, P<0.05]. At 1/6/12 months post-transplantation, serum creatinine levels were (76.1±18.5), (72.4±16.2) and (71.4±16.8) μmol/L in BT group and (160.3±33.4), (154.3±32.6) and (146.4±29.1) μmol/L in HCH group. The SCr in BT group at 1/6/12 months was lower than that in HCH group (P<0.05). Kaplan-meier analysis showed no significant inter-group difference in graft survival between two groups over a follow-up period of 12 to 36 months (Log-Rank test, P=0.485). Conclusions No significant difference exists in short-term survival rate of kidneys from HCH and BT donors. The recipients of HCH donor's kidney have higher serum creatinine levels than those of BT donors. Selective use of kidney transplants in patients with cardiac death caused by HCH may greatly reduce the waste of donor kidney and improve the quality-of-life of patients with end-stage renal disease. Key words: Kidney transplantation; Hypertension; Prognosis

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Chineae Journal of Organ Transplantation

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