Abstract:

Objective To observe the efficacy and survival status of single donor kidney transplantation with high Remuzzi score at zero-point biopsy. Methods A retrospective analysis was conducted on 178 recipients of single donor kidney transplantation who received deceased organ donation at the Second People's Hospital of Shanxi Province from January 2018 to January 2021. The donor kidneys underwent zeropoint biopsies and were evaluated with pathological Remuzzi scoring. The recipients were divided into high scoring group（≥ 4 and ≤ 6）and low scoring group（≤ 3）. The occurrence of delayed graft function of transplanted kidneys，postoperative renal function，occurrence of proteinuria，and survival of recipients and transplantedkidneys in both groups were observed with a follow-up time of 36 months. Results There were no statisticallysignificant differences（P ＞ 0.05）in gender ratio，body mass index，human leukocyte antigen（HLA）mismatch number，and donor kidney cold ischemia time between the two groups of recipients; there was no statistically significant difference in baseline blood creatinine and glomerular filtration rate before surgery（P ＞ 0.05）. A total number of 21 cases（23.6%）in the high scoring group experienced delayed graft function of transplanted kidneys after surgery，while 6 cases（6.7%）in the low scoring group experienced delayed graft function. The difference between the two groups was statistically significant（P ＜ 0.05），24 cases（27%）in the high scoring group developed proteinuria after surgery，while 9 cases（10.1%）developed proteinuria in the low scoring group. Through multiple factor analysis，it was found that the occurrence of proteinuria after kidney transplantation and the addition of mTOR immunosuppressants after surgery （OR ＝ 4.52， P ＜ 0.05）were related to thepreoperative Remuzzi score（OR ＝ 1.46，P ＜ 0.05）. At a follow-up of 36 months，the high scoring group had a blood creatinine level of（131.3±5.53）μmol/L and an eGFR level of（62.9±2.02）ml/（min · 1.73 m2 ）， while the low scoring group had a blood creatinine level of（121.3±2.18）μmol/L and an eGFR level of（65.0± 1.24）ml/（min·1.73 m2 ）. There was no statistically significant difference between the two groups（P ＞ 0.05）. Thesurvival rate of recipients in the high scoring group 36 months after surgery was 95.5%（85 cases），and the survival rate of transplanted kidneys was 95.5%（85 cases）. The survival rate of recipients in the low scoring group was 95.5% （85 cases），and the survival rate of transplanted kidneys was 97.7%（87 cases），with no statistically significant difference（P ＞ 0.05）. Conclusion Single kidney transplantation with a pre-transplant renal biopsy score of 6 ≥ Remuzzi ≥ 4 can achieve good long-term kidney survival and is worthy of clinical implementation. 

Key words:

Remuzziscore, Biopsy of transplanted kidney, Kidney transplantation

摘要：

目的 观察移植肾零点穿刺 Remuzzi 高评分的单供肾移植的疗效及生存情况。方法 回顾性分析 2018 年 1 月至 2021 年 1 月于山西省第二人民医院行公民逝世后器官捐献供者单供肾移植的受者 178 例。供肾均行零点穿刺，并行病理 Remuzzi 评分，分为高评分组（≥ 4 分且≤ 6 分）和低评分组（≤ 3 分）。随访 36 个月，观察两组术后移植肾延迟恢复发生情况，术后肾功能、蛋白尿发生情况，受者和移植肾存活情况。 结果 两组受者性别比例、体重指数、人类白细胞抗原（human leukocyte antigen，HLA）错配数、供肾冷缺血时间等无统计学差异（P ＞ 0.05）, 术前血肌酐及肾小球滤过率无统计学差异（P ＞ 0.05）。高评分组术后有 21（23.6%）例出现延迟恢复，低评分组有 6 例（6.7%）出现延迟恢复，两组之间差异有统计学意义（P ＜ 0.05）。高评分组术后有 24 例（27%）出现蛋白尿，低评分组有 9 例（10.1%）出现蛋白尿，行多因素分析，显示与术前 Remuzzi 评分（OR ＝ 1.46，P ＜ 0.05）及术后加用 mTOR 类免疫抑制剂（OR ＝ 4.52，P ＜ 0.05）有关。高评分组随访 36 个月时血肌酐为（131.3±5.53）μmol/L、eGFR 为（62.9±2.02）ml/（min·1.73 m2 ）， 低评分组血肌酐为（121.3±2.18）μmol/L、eGFR 为（65.0±1.24）ml/（min·1.73 m2 ），两组之间差异无统计学意义（P ＞ 0.05）。术后 36 个月高评分组受者存活率为 95.5%（85 例），移植肾存活率 95.5%（85 例）， 低评分组受者存活率为 95.5%（85 例），移植肾存活率为 97.7%（87 例），差异无统计学意义（P ＞ 0.05）。 结论 移植前供肾活检 6 分≥ Remuzzi ≥ 4 分的高评分行单供肾移植，可以取得良好的长期肾存活效果，值得临床开展。 

关键词:

 , Remuzzi 评分 , 移植肾病理 , 肾移植 ,