Application Research Of Time-zero Renal Biopsy Pathology For Donation After Cardiac Death

ObjectiveTo investigate the pathological characteristics of time-zero renal biopsy for donation after cardiac death and its predictive value for transplant prognosis,to further analyze the application value of time-zero renal biopsy.MethodsRetrospective analysis our hospital 188 recipients' information,such as pathology data of donor kidneys,general information,follow-up indicators(follow up to December 31,2017)and prognosis,the recipients who were conducted renal transplantation and received time-zero biopsy(all the specimens meet the requirements),which from August 12,2012 to November 12,2015,including 110 cases of DCD donor kidney,78 cases of living donor kidney.According to Remuzzi scoring method,the renal pathological data were quantified and graded,and statistical analysis the correlation between pathological grading and postoperative clinical indexes.Result1.There were 177 pathological changes in 188 cases of donor kidney.Among them,DCD group 103 cases,relatives living group 74 cases.Kidney pathological changes based on atherosclerosis,mesangial cells/matrix hyperplasia,glomerulosclerosis,tubular degeneration,tubular atrophy and interstitial fibrosis1.The difference was statistically significant in pathological changes among two groups were renal tubular degeneration,interstitial inflammatory cell infiltration.(DCD groups are the highest proportion)2.The proportion of postoperative DGF in DCD group was higher than in relatives living group,with significant difference.The number of recipients whose creatinine returned to normal and urine protein turned out to negative 7 days or within 30 days after operation in relative living group were higher than those in DCD group,the difference was statistically significant.3.There was a positive linear correlation between Remuzzi score and serum creatinine at 1 days,7 days,1 months,6 months,1 years,2 years,3 years,4years after operation(the higher integral,the higher serum creatinine).There was a negative liner correlation with glomerular filtration rate(the higher integral,the lower glomerular filtration rate).4.There was no significant difference between Remuzzi 0-3 group and 4-7 group in most of the postoperative complications.Only in the incidence of AR and PNF,4-7 group was significantly higher than 0-3 group,the difference was statistically significant.5.GS%>20% groups had higher levels of serum creatinine,urea nitrogen and lower glomerular filtration rate than those of the other three groups(0% groups,1%-10% groups and 11%-20% groups)at different time points after operation,the difference was statistically significant.GS% > 20% groups in the incidence of postoperative DGF and PNF was significantly higher than ?20% groups,the difference was statistically significant.6.There was no significant difference in human/renal survival rates between DCD group and relative living group during the follow-up period.The human/renal survival rate in Remuzzi 0-3 group was better than that of 4-7 group,the difference was statistically significant.GS%?20% groups' renal survival rate was better than that of >20% groups,the difference was statistically significant;There was no significant difference in human survival rate between the two groups.ConclusionThe long-term human/renal survival rate of DCD group is similar to relative living group,and can be used as an ideal source of donor kidney.Time-Zero biopsy pathology can predict renal function and human/renal survival rate after transplantion,It can be good for our clinical decision-making and treatment.