| BackgroundKidney transplantation is the preferred treatment mode for patients with end-stage renal disease.The shortage of donors and the long waiting time of kidney transplant patients have prompted medical workers to expand the standard of kidney donation and increase the source of kidney donation.Resently,the main types of donation is cardiac death organ donation(DCD),because the DCD are olderly,accompanied with basic diseases such as hypertension,diabetes,especially for organ is the longger warm ischemia time,the more organ ischemia-reperfusion injury(IRI),There would be more delayed graft function(DGF).By observing the structures of glomeruli,renal tubules,renal interstitium and renal vessels,preoperative pathological biopsy of donor kidney can effectively evaluate the quality of donor kidney and determine the choice of donor kidney.It not only makes efficient use of marginal donor kidney,but also provides pathological baseline data for postoperative diagnosis and treatment of patients.ObjectiveTo explore the effect of preoperative pathological biopsy lesion degree on renal function and survival of kidney transplantation from donation after cardiac death(DCD)? MethodsKidney transplantation from DCD donors from February 1,2015 to February 1,2018 was retrospectively reviewed.There were donors((n=69),male donor(n=56)and famale donors(n=13).The causes of death were brain trauma(n = 22),cerebrovascular accident(n = 38),brain tumor or carbon monoxide poisoning(n = 9).A total of 138 kidneys were donated in 69 donors,and pathological biopsy was performed before surgery.Exclude the following:the renal pathological score was ?6 points(n=4);the second transplantation(n=2);combined liver and kidney transplantation(n=1);the pathological section was less than 10 glomeruli(n=1).A total of 130 recipients were male receptors(n=90)and female receptors(n=40).130 kidneys were divided into two groups according to the Pirani score system,high group(n=36)(4-5 points)and low group(n=94)(0-3 points).(1)for the histopathological examination of the donor kidney,each section must contain four parts at the same time: the glomeruli,renal tubules,renal interstitium and renal small blood vessels;(2)the number of glomeruli in each section must be greater than 10;(3)Pirani score of donor kidney < 6;(4)the urine volume before donor acquisition was greater than 100 mL per hour.(5)the donor had no history of cardiopulmonary resuscitation.After kidney procurement,perfusion and dressing,the upper pole of the kidney was obtuse punctured with 16 G bard needle,and two tissues were punctured in each kidney.HE staining,PAS staining,Masson staining and immunofluorescence detection were performed routinely.All pathological sections were evaluated by a pathologist using Pirani scoring system for glomerular,tubule,interstitial,and vascular lesions.There were two groups according to the Pirani pathology score of the donor kidney,with low score(0-3 points)(94 cases)and high score(4-5 points)(36 cases).A retrospective analysis was performed to compare the prognosis of renal transplantation patients in the two groups,including primary nonfunctional renal transplantation(PNF),delayed graft recovery(DGF),incidence of postoperative rejection,serum creatinine at 1,3,6,12 and 24 months after surgery,and survival rate of renal transplantation at 12-36 months.ResultsThere were statistically significant differences in donor age,history of hypertension,length of stay in the ICU,and cause of death between high and low pathological groups(t =8.25,P < 0.05,2=16.53,P < 0.05,t =4.93,P < 0.05,t =4.648,P< 0.05).The incidence of postoperative DGF was significantly higher in the high group than in the low group(2=5.657,P < 0.05).The serum creatinine values at 1,3,6,12,and 24 months after surgery of the low-group recipients were lower than those of the high-group,with statistically significant differences(t =2.922,P < 0.05,t =3.217,P < 0.05,t =5.51,P < 0.05,t =3.532,P < 0.05,t =4.76,P < 0.05).Kaplan-Meier analysis showed that there was no significant difference in the cumulative survival rate of human/transplant kidney between the high-grade pathology group(36 cases)and the pathological low group(94 cases)(log-rank test,P=0.106,P=0.296,P >0.05).ConglusionsThe age of the donor,the length of ICU stay,the history of hypertension and the cause of death of the donor are the clinical factors influencing the pathological score.DCD preoperative pathological biopsy can effectively evaluate the quality of donor kidney and provide a reference for the evaluation of postoperative renal transplant function. |
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