Clinical study on kidney allograft transplantation from marginal donors with high pathological Remuzzi score in preimplantation biopsy / 中华器官移植杂志

ABSTRACT

Objective:To explore the outcome of kidney transplantation from donation after cadaveric death(DCD)with high pathological Remuzzi score.Methods:From January, 2019 to December, 2019, 31 recipients of kidney allograft transplantation from marginal donors with Remuzzi score≥4 in preimplantation biopsy were retrospectively enrolled. They were divided into two groups of dual kidney transplantation(DKT, 14 cases)and single kidney transplantation(SKT, 17 cases). Median Remuzzi score of left kidney(5.05 in DKT group vs 4.92 in SKT group)or right kidney(5.26 vs. 4.58)was comparable. Dual donor kidneys were implanted into ipsilateral iliac fossa. Survival outcomes, kidney function, acute rejection episodes, incidence of delayed graft function(DGF)and proteinuria were recorded within Year 1 post-operation.Results:Proportion of male(92.9% vs. 52.9%, P<0.05)and recipient's body mass index(BMI, 23.93 vs. 21.09)were significant higher in DKT group than those in SKT group. One graft failure occurred in DKT group at Month 11 post-operation. The 1-year graft survival rate was 92.9% in DKT group and 1-year recipient survival rate both 100% in two groups. Mean 12-month serum creatinine[SCr, (164±37.7)μmol/L vs. (154.92±96.2)μmol/L]and estimated glomerular filtration rate[eGFR, (41.84±9.01) vs. (44.8±18.16)ml/(min·1.73m 2)]were comparable between two groups(both P>0.05). There was no occurrence of thrombosis resulting in graft loss. One-year incidence of acute rejection, rate of DGF(42.9% vs 41.2%)and proteinuria(57.1% vs. 41.2%)were comparable between two groups(both P>0.05). Conclusions:Through donor-recipient matching and dual kidney transplant allocation, short-term survival outcome of kidney allograft from marginal donors with high Remuzzi score≥4 is encouraging. However, long-term outcomes should be further examined.