Utjecaj odgođene funkcije presatka na progresiju kroničnih histoloških promjena u presađenom bubregu [The impact of delayed graft function on progression of chronic histological changes in transplanted kidney]

Maksimović, Bojana (2018) Utjecaj odgođene funkcije presatka na progresiju kroničnih histoloških promjena u presađenom bubregu [The impact of delayed graft function on progression of chronic histological changes in transplanted kidney]. PhD thesis, Sveučilište u Zagrebu.

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Abstract

Background and objectives: Delayed graft function (DGF) is a manifestation of acute kidney injury resulting from ischemia-reperfusion injury. It has usually been defined as the need for dialysis within 7 days after transplantation. Aim of our study was to evaluate effect of delayed graft function on the progression of fybrosis in transplanted kidney after deceased donor kidney or kidney pancreas transplantation. Methods and materials: Our study was retrospective. We included 163 consecutive patients transplanted in our center from 2007 to 2014. Kidney graft only, and kidney pancreas transplanted patients were included. Patients without paired biopsies (day 0 and 12 moths postransplant) were excluded. The primary outcome was the one year progression of chronic histology changes based on protocol biopses performed on the day of transplantation and at 12 months postransplant. We used composite chronic histological score as a marker of chronic allograft injury, and separate chronic scores ci and ct. The composit score is a sum of Banff chronic scores ci,ct,ah and cv (therefore, score value range 0–12). We analysed the distribution of the change (Δ score) in the composite score between group of patients with and without delayed graft function on paired biopsies, and distribution of change for separate scores. We also analysed impact of DGF on graft survival and graft function in our cohort of patients. Results: There were 60 patients with DGF (36.8%) in our cohort. Follow up was 1665 ± 590 days. Chronic composite histological score were statisticaly significantly higher in all biopsies at 12 months after transplantation (1.92 ± 2.16 at 0 biopsies vs. 3.56 ± 2.93 at 12 months biopses, p<0.001). In univariate analysis DGF was correlated with composite chronic histological score and with the change of the score (Δ). In a multivariate analysis DGF was not correlated with composite chronic histological score at 12 months (p=0.417) but it was correlated with change of the score (Δ) (p=0.012). DGF was not correlated with ci and ct at 12 months, and it was also not correlated with change of ci and ct score (Δ). Graft and patient survival was similar in both groups. Conclusion: Chronic allograft injury, as measured by a composite score and separate scores, ci and ct increased only mildly in the first post-transplant year. Delayed graft function does not seem to be a major drive of a chronic allograft injury during first post-transplant year.

Abstract in Croatian

Uvod: Odgođena funkcija presatka (OFP) mainfestacija je akutne bubrežne ozljede koja nastaje kao poslijedica ishemijsko reperfuzijskog oštećenja. Obično je definirana kao potreba za dijalizom u prvih 7 dana nakon transplantacije. Cilj ovog istraživanja bio je analizirati povezanost OFP-a s progresijom fibroze u transplantiranom bubregu. Metode i materijali: Istraživanje je bilo retrospektivno. Uključeno je 163 konsekutivna bolesnika kod kojih je učinjena transplantacija u našem centru od 2007. do 2014. godine. Isključeni su bili bolesnici kod kojih nisu učinjene protokolarane biopsije, 0 dan i 12 mjeseci nakon transplantacije te oni s neadekvatnim uzorcima. Primarna mjera ishoda bila je progresija kroničnih histoloških promjena u transplantiranom bubregu u prvoj godini nakon transplantacije. Kao surogat marker kronične ozljede presatka koristili smo složeni kronični histološki skor (SKS) i pojedinačne histološke skorove ci i ct. Složeni kronični skor (SKS) sastojao se od zbroja pojedinačnih kroničnih skorova prema Banff klasifikaciji, ci+ct+cv+ah (vrijednost skora od 0 do 12). Analizirali smo promjenu (Δ) SKS-a u skupini sa i bez odgođene funkcije presatka (OFP) i promjenu (Δ) pojedinačnih skorova u ovisnosti o OFP-u. Dodatno smo analizirali povezanost OFP-a s preživljenjem presatka i bolesnika uključenih u našu skupinu. Rezultati: Ukupno je bilo 60 bolesnika s OFP-om (36.8 %). Prosječno vrijeme praćenja bilo je 1665 ± 590 dana. SKS je bio statistički značajno viši u svim biopsijama nakon 12 mjeseci (1.92 ± 2.16 u 0 biopsijama vs. 3.56 ± 2.93 u biopsijama nakon 12 mjeseci, p<0.001). U univarijatnoj analizi OFP je bila povezana sa SKS-om i njegovom promjenom (Δ). U multivarijatnoj analizi OFP nije bila povezana sa SKS-om na 12 mjeseci (p=0.417), ali je bila povezana s promjenom SKS-a (Δ) (p=0.012). U multivarijatnoj analizi OFP nije bila povezana s ci i ct na 12 mjeseci, niti s njihovom promjenom (Δ). Preživljenje presatka i bolesnika bilo je podjednako u obje skupine, neovisno o OFP-u. Zaključak: Kronična ozljeda presatka mjerena složenim kroničnim histološkim skorom, kao i pojedinačnim kroničnim skorovima ci i ct samo se umjereno povećava u prvoj godini nakon transplantacije. Čini se da OFP nije neovisni čimbenik rizika koji dovodi do progresije patohistoloških promjena u presatku.

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