The Application Value Of Time-zero Renal Biopsy In Donation After Cardiac Death And Living Donor Kidney Transplantation

Predictive value of chronic histopathology changes in time-zero renal biopsy for the early allograft's function after cardiac death kidney transplantationObjective:To investigate the effect of common chronic lesions in donation after cardiac death(DCD)donors' time-zero renal biopsy(TO-RBx)specimens on the allografts' function early after kidney transplantation.Methods:54 TO-RBx specimens from DCD donors obtained at Nanjing General Hospital from January,2011 to June,2017 were retrospectively reviewed.According to the 2007 Banff criteria,common chronic pathologic changes including global glomeruloscerosis(GS),chronic tubular atrophy(CT),chronic interstitial fibrosis(CI),arteriolar hyaline thickening(AH)and chronic vascular fibrous intimal thickening(CV)were respectively scored.The difference of pathologic changes between donors died of cerebral hemorrhage or trauma was evaluated.The effect of different lesions on allografts' function was investigated during 6 months after renal transplantation.Results:Of all 54 TO-RBx specimens,26 cases(48.15%)with GS,among them 23 were mild change and 3 were moderate change;17 cases(31.48%)with CT,16 were mild change and 1 were moderate change;7 cases with CI,and all were mild change;19 cases(35.19%)with AH,18 were mild change and 1 were moderate change;13 cases with CV,all were mild change.The percentage of GS was higher in donors died from cerebral hemorrhage than in donors died from cerebral trauma(P=0.006),and the renal allograft' s glomerular filtration rate(eGFR)from the former donors were lower than that from the latter donors(P=0.047).GS and AH changes all have independent influence on allografts' function within 6 months after renal transplantation(P=0.031;P=0.043).Conclusion:Time-zero renal biopsy in DCD donors has predictive value for the allograft's function,is one of the instructions for recipients' immunosuppressive regiments after renal transplantation.The application value of time-zero renal biopsy in living donor kidney transplantationObjective:To investigate the chronic pathologic changes in living donors by time-zero renal biopsy(TO-RBx)and evaluate its risk factors as well as predictive value in the allograft function of recipients early after living dononation kidney transplantation.Methods:TO-RBx from DCD donors obtained at Nanjing General Hospital from January,2011 to June,2017 were retrospectively reviewed according to the 2007 Banff criteria.Common chronic pathologic changes such as global glomeruloscerosis(GS),chronic tubular atrophy(CT),chronic interstitial fibrosis(CI),arteriolar hyaline thickening(AH)and chronic vascular fibrous intimal thickening(CV)were respectively scored.Next,analyze the risk factors for different pathological changes and evaluate its predictive value in the allograft function of recipients during 6 months after living dononation renal transplantation.Results:Of all the time-zero renal biopsy specimens,23 cases(25.84%)with GS(21 were mild change,1 were moderate change and 1 were severe change),33 cases(37.08%)with chronic tubular/interstitial changes(30 were mild change and 3 were moderate change)and 37 cases(1.57%)with arterial changes(36 were mild change and 1 were moderate change).Univariate analysis showed,GS was related to donor age(P=0.042);tubular/interstitial changes were related to donor age,sex and systolic blood pressure(P=0.019;0.006;0.01);arterial changes were related to donor sex and blood triglyceride level(P=0.029;0.049).Furthermore,multivariate regression analysis also shows,GS was associated with donor age(OR[95%CI],1.086[1.001-1.177];P=0.047);tubular/interstitial changes were associated with donor systolic blood pressure(OR[95%CI],1.059[1.012-1.109];P=0.013);arterial changes were associated with donor sex(OR[95%CI],2.908[1.093-7.738];P=0.033).Within 6 months after living donor renal transplantation,theeGFR of grafts with GS lesions were lower than grafts without GS lesions,and it is statistically significant(P=0.013).Conclusion:Time-zerorenalbiopsycan detect the latent pathologic changes in living donors and is one of the important methods for the prognosis of renal transplant donor and recipients.