摘要目的 探讨供肾零点活组织检查马里兰病理指数在公民逝世后供者器官捐献供肾评估中的意义.方法 2015年1月至2015年12月吉林大学第一医院62例器官捐献者捐献供肾124个,评估后弃用供肾1个,共完成123例供肾移植.123个供肾进行了零点穿刺活组织检查,行快速冰冻病理学检查,用马里兰病理指数对结果进行分级:低危险组(≤7分)112例;中危险组(8～11分)11例、高危险组(≥12分)0例.观察低危险组和中危险组的移植肾功能恢复延迟(DGF)发生率,围手术期急性排斥反应(AR)发生率,术后1年内各时间点的受者血肌酐值.随访中位时间19个月,观察两组受者和移植肾术后1年存活率.结果 123例肾移植全部成功.低危险组和中危险组的DGF发生率分别为6.3％(7/112)和27.3％(3/11)(P=0.046).低危险组和中危险组围手术期AR的发生率分别为9.8％(11/112)和27.3％(3/11)(P=0.112).术后7d、1个月、3个月、12个月受者的血肌酐值,低危险组分别为(123.3±79.7)μmol/L、(104.4±52.6)μmol/L、(72.9±32.0)μmol/L、(107.6±34.6)μmol/L;中危险组分别为(321.0±74.3)μmol/L、(172.6±59.9) μmol/L、(142.9±45.7)μmol/L、(140.8±63.6)μmol/L.低危险组术后1年内各时间点血肌酐明显低于中危险组(P＜0.000 1,P=0.000 3,P＜0.000 1,P=0.012).低危险组受者和移植肾1年存活率为98.2％(110/112)和98.2％(110/112),中危险组受者和移植肾1年存活率为81.8％(9/11)和81.8％ (9/11) (P=0.040).结论 根据供肾零点穿刺快速冰冻病理学检查的马里兰病理指数对供肾质量进行评估,对于判断预后有一定的指导意义.低危险组的供肾移植后DGF发生率较低,术后1年内受者的肾功能恢复较好,受者和移植肾存活率更高.

abstractsObjective To investigate the significance of The Maryland Aggregate Pathology Index in the evaluation of donation after citizens death (DCD) kidney by time-zero renal biopsy.Methods 124 kidney grafts were donated by 62 donors after cardiac death in First Hospital of Jilin University between Jan.2015 and Dec.2015.One kidney was deprecated after evaluation and 123 transplants were performed eventually.Time-zero renal biopsy was performed on 123 cases of DCD donor kidney,and rapid frozen pathological examination was performed.The pathological results of donor kidneys were graded by The Maryland Aggregate Pathology Index:low risk group (less than 7 points) (n =112 cases);the middle risk group (8-11 points) (n =11 cases),high the risk group (more than 12 points) (n =0).The incidence of delayed graft function (DGF),the incidence of perioperative acute rejection (AR),and the average creatinine level in the patients at different time points one year post-transplantation were observed.The median value of follow-up was 19 months,and the 1-year survival rate of patients and renal grafts was observed.Results All 123 cases of kidney transplantation from DCD were performed successfully.The incidence of DGF in low risk group and in middle risk group was 6.3％ (7/112) and 27.3％ (3/11),respectively (P =0.046).The incidence of perioperative acute rejection (AR) in low risk group and middle risk group was 9.8％ (11/112) and 27.3％ (3/11),respectively (P =0.112).The mean serum creatinine (Scr) levels at 7th day,1st month,3rd month,and 12th month after operation were 123.3 ± 79.7,104.4 ± 52.6,72.9 ± 32.0 and 107.6 ± 34.6 μmol/L in low risk group,and 321.0 ± 74.3,172.6 ± 59.9,142.9 ± 45.7 and 140.8 ± 63.6 μmol/L in middle risk group,respectively.The mean Scr levels in patients at different time points one year post-transplantation in low risk group were significantly lower than those in middle risk group (P＜0.000 1,=0.000 3,＜0.000 1,=0.012 respectively).The 1-year survival rate of patients and renal grafts was 98.2％ (10/112)/98.2 (110/112 in low risk group,and 81.8％ (9/11)/81.8％ (9/11) in middle risk group,respectively (P =0.040).Conclusion The Maryland aggregate pathology index obtained from time-zero renal biopsy of rapid frozen pathological examination can provide some guidance for the evaluation of the quality of DCD and the prognosis.Incidence of DGF was lower in low risk group than that in middle risk group,and the renal function of each time point was better within 1 year,and the 1-year survival rate of patients and renal grafts was higher.