Significance of The Maryland Aggregate Pathology Index in the evaluation of donation after citizens death (DCD) kidney by time-zero renal biopsy / 中华器官移植杂志

ABSTRACT

Objective 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 Indexlow 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.