CAJ | 학술논문

目的探讨零点活组织检查冷冻切片组织病理学半定量评分在心死亡器官捐赠(DCD)供肾损伤程度评估中的临床意义.方法 2005年7月到2009年12月实施的DCD供肾获取16例,记录供者死亡时血肌酐(SCr),供肾热、冷缺血时间,用零点活组织检查供肾组织冷冻切片的组织学半定量评分对供肾进行评级.观察符合人组条件的受者移植后肾功能恢复时间、移植肾功能恢复延迟(DGF)发生率、急性排斥反应(AR)发生率、平均Scr及受者和移植肾存活率,以及感染、肿瘤、糖尿病等术后并发症发病率等.结果 DCD供者16例,按供肾评分分为A、B、C3级.A级供者年龄和热缺血时间明显低于B级和C级,C级的热缺血时间和死亡时Scr明显高于A与B级.21例受者分别接受来自14例供者的21个肾脏(其中A级13个,B级8个,C级未应用于移植).接受A级供肾移植者DGF发生率和移植肾存活率明显优于B级受者.移植后3个月和3年时A级受者Scr优于B级受者.结论根据供肾零点活组织检查的组织学改变,可以进行DCD供肾损伤的初步评估;影响组织学评分因素可能因素包括年龄、热缺血时间、供肾获取时的Scr等;组织学评分高的供肾移植后恢复较好,受者GDF发生率和严重程度较低.
목적 탐토영점활조직검사냉동절편조직병이학반정량평분재심사망기관연증(DCD)공신손상정도평고중적림상의의.방법 2005년7월도2009년12월실시적DCD공신획취16례,기록공자사망시혈기항(SCr),공신열、랭결혈시간,용영점활조직검사공신조직냉동절편적조직학반정량평분대공신진행평급.관찰부합인조조건적수자이식후신공능회복시간、이식신공능회복연지(DGF)발생솔、급성배척반응(AR)발생솔、평균Scr급수자화이식신존활솔,이급감염、종류、당뇨병등술후병발증발병솔등.결과 DCD공자16례,안공신평분분위A、B、C3급.A급공자년령화열결혈시간명현저우B급화C급,C급적열결혈시간화사망시Scr명현고우A여B급.21례수자분별접수래자14례공자적21개신장(기중A급13개,B급8개,C급미응용우이식).접수A급공신이식자DGF발생솔화이식신존활솔명현우우B급수자.이식후3개월화3년시A급수자Scr우우B급수자.결론 근거공신영점활조직검사적조직학개변,가이진행DCD공신손상적초보평고;영향조직학평분인소가능인소포괄년령、열결혈시간、공신획취시적Scr등;조직학평분고적공신이식후회복교호,수자GDF발생솔화엄중정도교저.
Objective Through two-center,and controlled clinical study,we have made histopathological evaluations of semi-quantitative method by cryosections of zero biopsy,and combining with donor age,gender,ischemia time,biochemical parameters at death to assess donation after cardiac death (DCD) kidney injury and to establish the histopathological criterion for clinical acceptance or rejection of DCD kidney.Also we want to discover the relationships between the degree of donor renal injury and transplanted renal prognosis,and to verify clinical significance and modify the criterion of histopathological semi-quantitative evaluation of DCD kidney frozen section.Method The serum creatinine (SCr) at death,warm and cold ischemia time,and histopathological semi-quantitative score (self-made) of zero biopsy frozen section in donors were recorded.The incidence of DGF and acute rejection (AR),mean SCr,patient and graft survival,and other complications morbidity including infection,cancer,diabetes etc.after transplantion of the DCD kidney in recipients were observed.Results There were 16 cases from DCD cadavers,which could be divided into grade A,B and C according to the merits of the histological score.The age was younger and warm ischemia time was shorter significantly in grade A than in grade B and C.The warm ischemia time was longer and SCr level at death was higher significantly in grade C that in grade A and B.The DCD kidneys in grade C were abandoned because their histology showed serious damage and may not resume after transplantation.Furthermore,21 cases have received 21 kidneys from 14 donors including 13 of grade A and 8 of grade B.For grade A,the incidence of DGF was lower and renal survival rate was higher significantly after transplantation than in grade B.At 3rd month and 3rd year after transplantation,average Scr level in grade A was lower than in in grade B.Conclusion Donor kidney zero biopsy shows that histological changes are synchronous to the pathophysiological changes of renal injury,which almost can accurately and truthfully reflect the donor kidney injury.Histopathological semiquantitative score of cryosections can be used as an accurate way to assess DCD kidney injury.The important influencing factors on histopathological scores are as follows:age,warm ischemia time,SCr level at death.The higher histopathological semi-quantitative score is,the better transplanted kidneys recover,and the lower the incidence and severity of GDF occurs.