The Predictive Value Of Post-Reperfusion Kidney Biopsy Assessment On Early Graft Outcome

Objective:To determine the predictive value of post-reperfusion kidney biopsy for renal function and the incidence rate of DGF in cadaver donor kidney transplant recipients within 1 year after kidney transplantation,and to analyze the pathological risk factors of early prognosis of kidney transplantion.Methods:This study was a retrospective study and included 461 patients who accepted the donation after the death of citizen,from the October 11,2010 to April 30,2017 at the Renal Disease Center of the First Affiliated Hospital of Zhejiang University School of Medicine.Post-reperfusion kidney biopsy pathology and clinical data of donors and recipients were scored.According to the Remuzzi criteria for post-reperfusion kidney biopsy,comparing the pathological differences of biopsy and graft prognosis between right and left donor kidneys from the same donor.According to the Remuzzi score,?3 was divided into low group,4-6 group was divided into middle group,>6 was divided into high group,and the incidence of delayed graft function(DGF)was observed between the 3 groups.Incidence of acute rejection(AR)within 1 year after surgery,and differences in renal function at 1 week,2 weeks,1 month,2 months,3 months,.6 months,and 1 year after surgery.A multivariate analysis was conducted on the risk factors of kidney function and DGF incidence in kidney transplantion.According to the presence or absence of hyaline degeneration of the arterioles,the groups were divided into negative group and positive group,the estimated glomerular filtration rate(estimated)at 1 year after renal transplantation between the two groups was compared.The incidence of DGF and graft kidney function at 1 year were analyzed in patients with Remuzzi score>3.Results:The study included 315 donors and 461 donor kidneys.Of the 461 recipients,458 recipients have good graft function and 3 grafts failed.There was no significant difference in post-reperfusion kidney biopsy between the left and right kidneys from the same donor(p>0.05).There was no difference in the incidence of graft DGF and renal function at each time point after transplantation(p>0.05).Among 461 kidney donors,they were grouped according to the Remuzzi score:406 cases(88.1%)in low group(<3 points),48 cases(10.4%)in middle group(4-6 points),and 7 cases(1.5%)in high group(>6 points);Respectively,the incidence of DGF in the transplanted kidney was 13.3%,33.3%,and 42.9%,the difference was statistically significant(p<0.05).The differences of eGFR between 1 week,2 weeks,1 month,2 months,3 months,6 months,and 1 year were statistically significant(p<0.05).Multivariate analysis revealed that terminal serum creatinine concentration and Remuzzi score were independent predictors of DGF after transplantation(p<0.05).Vascular scores,donor age,donor gender,death due to cerebrovascular accident,occurrence of DGF,and occurrence of rejection were independent risk factors affecting renal function at 1 year after transplantation(p<0.05).The 1-year eGFR of the hyaline degeneration-negative group was 73.24±20.29 ml/min/1.73m2,and the 1-year eGFR of the positive group was 58.15±20.93 ml/min/1.73m2.Significance(p<0.05).Among the 48 patients who's Remuzzi scores was 4 to 6,35(72.9%)had a glomerular filtration rate of>45 ml/min/1,73 m2 at and 13(27.1%)<45 ml/min/1.73 m2.Donors with younger age,history of non-hypertension deaths,renal function was better one year after transplantation.In the 7 patients with Remuzzi scores>6,5 patients' 1-year glomerular filtration rate was>45 ml/min/1.73 m2,and 2 patients'1-year glomerular filtration rate of was<45 ml/min/1.73 m2.Conclusion:The biopsy pathology of donor-renal reperfusion can reflect the donor's baseline data.The assessment of donor kidney quality based on the biopsy pathology after reperfusion for donor kidney has certain guiding significance for predicting renal function in a short period of time.Renal vascular disease may be an independent predictor of poor prognosis of the graft.However,if only according to the Remuzzi criterion to decide whether to perform dual kidney transplantation or discard,it will increase the rate of discarded kidneys.It is still necessary to combine the donor's clinical data and find suitable recipients to increase the utilization of the renal assessment.