-
摘要:
目的 研究老龄供肾在青年受者体内的病理学改变, 探讨老龄供肾移植的安全性。 方法 研究对象选择2008年1月至2008年12月期间在广州医科大学附属第二医院移植科实施亲属活体供肾移植的14例老龄供者(年龄>55岁)和14例青年受者(年龄 < 30岁)。对每例老龄供肾进行零时活组织检查(活检), 对接受老龄供肾的青年受者在移植后6个月进行常规的移植肾活检。观察老龄供肾移植后的肾脏组织病理结构改变。 结果 老龄供肾移植至青年受者体内6个月后组织病理结构发生改变:肾小动脉病变程度较移植前减轻; 肾小动脉硬化指数较移植前减轻(P < 0.05);肾小球硬化比例移植前后变化不大(P > 0.05)。纤维连接蛋白(FN)水平较移植术前表达水平降低, 但差异无统计学意义(P > 0.05);层黏连蛋白(LN)表达水平较移植前降低(P < 0.05)。 结论 老龄供肾移植到青年受者体内后, 其组织病理学结构有所改善。 Abstract:Objective To study the pathological changes of renal grafts from elderly donor in young recipients and to investigate the safety of kidney transplantation from elderly donors. Methods Fourteen elderly kidney donors (with the age > 55 years old) and fourteen young recipients (with the age < 30 years old) underwent living related donor renal transplantation at the Department of Transplantation of the Second Affiliated Hospital of Guangzhou Medical University from January 2008 to December 2008 were enrolled as the object of study. Every elderly donor kidney was performed time-zero biopsy and every young recipient was performed routine renal graft biopsy 6 months after transplantation. The pathological and structural changes of kidney tissues after renal transplantation from elderly donors were observed. Results The histopathological changes occurred at 6 months after transplantation from elderly kidney donors to young recipients. Compared with those before transplantation, the severity of renal arteriolar lesion and the index of renal arteriolar sclerosis alleviated after transplantation(P < 0.05), and the ratio of glomerulosclerosis did not change after transplantation (P > 0.05). The expression of fibronectin (FN) decreased after transplantation, but the difference had no statistical significance (P > 0.05). The expression of laminin (LN) decreased after transplantation (P < 0.05). Conclusions The histopathological structure of renal graft from elderly donors in young recipients has improved. -
Key words:
- Living transplantation /
- Age /
- Donor /
- Glomerulosclerosis /
- Renal interstitial fibrosis /
- Extracellular matrix
-
表 1 老龄供肾移植前与移植后肾小动脉病变程度变化
Table 1. Changes of renal arteriole lesion degree before and after elderly donor renal transplantation (n)
时间 n 肾小动脉病变程度 - ± + ++ 移植前 14 2 2 5 5 移植后 14 2 6 6 0 表 2 老龄供肾移植前与移植后FN和LN表达的比较
Table 2. Comparison of FN and LN expression before and after elderly donor renal transplantation(x±s)
时间 n FN LN 移植前 14 0.180±0.016 0.202±0.011 移植后 14 0.164±0.026 0.156±0.013 P值 0.087 0.019 -
[1] Lionaki S, Kapsia H, Makropoulos I, et al. Kidney transplantation outcomes from expanded criteria donors, standard criteria donors or living donors older than 60 years[J]. Ren Fail, 2014, 36(4):526-533. doi: 10.3109/0886022X.2013.876348 [2] Li Y, Li J, Fu Q, et al. Kidney transplantation from living related donors aged more than 60 years:a single center experience[J]. Ren Fail, 2013, 35(9):1251-1254. doi: 10.3109/0886022X.2013.823873 [3] Ferrari P, Lim W, Dent H, et al. Effect of donor-recipient age difference on graft function and survival in live-donor kidney transplantation[J]. Nephrol Dial Transplant, 2011, 26(2):702-708. doi: 10.1093/ndt/gfq383 [4] 李明喜, Nicholls K.肾移植供者的肾小动脉病变和肾小球硬化[J].肾脏病与透析肾移植杂志, 2001, 10(3):228-232. http://www.cnki.com.cn/Article/CJFDTOTAL-SZBY200103005.htmLi MX, Nicholls K. Renal arteriole lesion and glomerulosclerosis in donor kidneys[J]. Chin J Nephrol Dial Transplant, 2001, 10(3):228-232. http://www.cnki.com.cn/Article/CJFDTOTAL-SZBY200103005.htm [5] Wanner N, Hartleben B, Herbach N, et al. Unraveling the role of podocyte turnover in glomerular aging and injury[J]. J Am Soc Nephrol, 2014, 25(4):707-716. doi: 10.1681/ASN.2013050452 [6] Takeda T, Imada A, Horiuchi A, et al. Age-related changes in morphological studies in rat and human kidney[J]. Nippon Jinzo Gakkai Shi, 1996, 38(12):555-662. https://www.ncbi.nlm.nih.gov/pubmed/9014474 [7] Ruiz-Torres MP, Bosch RJ, O'Valle F, et al. Age-related increase in expression of TGF-beta 1 in the rat kidney:relationship to morphologic changes[J]. J Am Soc Nephrol, 1998, 9(5):782-791. http://www.ncbi.nlm.nih.gov/pubmed/9596075 [8] 丰贵文, 李金锋, 王跃, 等.西罗莫司替换钙调磷酸酶抑制剂治疗老年亲属供肾移植受者移植肾功能减退的疗效[J].器官移植, 2011, 2(4):194-196. http://www.cnki.com.cn/Article/CJFDTOTAL-QGYZ201104006.htmFeng GW, Li JF, Wang Y, et al. Effect of conversion from calcineurin inhibitors to sirolimus for renal function deterioration in living-related renal transplantation from elderly donors[J]. Organ Transplant, 2011, 2(4):194-196. http://www.cnki.com.cn/Article/CJFDTOTAL-QGYZ201104006.htm [9] 陈莉萍, 张晓琳, 钱叶勇, 等.老年肾移植受者的临床分析与管理[J].中华器官移植杂志, 2014, 35(2):82-85. http://d.wanfangdata.com.cn/Periodical/zhqgyz98201402005Chen LP, Zhang XL, Qian YY, et al. Clinical analysis and management of kidney transplantation in the older adults:monocentric retrospective analysis[J]. Chin J Organ Transplant, 2014, 35(2):82-85. http://d.wanfangdata.com.cn/Periodical/zhqgyz98201402005 [10] Faconti L, Bruno RM, Ghiadoni L, et al.Ventricular and vascular stiffening in aging and hypertension[J]. Curr Hypertens Rev, 2015, 107:139-146. http://www.ncbi.nlm.nih.gov/pubmed/26022209 [11] 李虹, 白小涓, 刘强, 等.血管紧张素Ⅱ和NADPH氧化酶与血管衰老的相关性研究[J].中国老年学杂志, 2006, 26(4):493-496. http://www.cnki.com.cn/Article/CJFDTOTAL-ZLXZ200604029.htmLi H, Bai XJ, Liu Q, et al. Study on the relationship between angiotensin Ⅱ and NADPH oxidase and vascular aging[J]. Chin J Gerontol, 2006, 26(4):493-496. http://www.cnki.com.cn/Article/CJFDTOTAL-ZLXZ200604029.htm [12] Varcoe RL, Teo AB, Pelletier MH, et al. A nitinol "U-Clip" versus sutured arteriovenous anastomosis:local tissue response and intimal hyperplasia development in a sheep model[J]. Eur J Vasc Endovasc Surg, 2015, 49(3):344-352. doi: 10.1016/j.ejvs.2014.12.025 [13] 刘强, 白小涓, 李虹, 等.衰老大鼠主动脉增龄性重塑及其规律分析[J].中国老年学杂志, 2007, 27(7):612-614. http://www.cnki.com.cn/Article/CJFDTOTAL-ZLXZ200707007.htmLiu Q, Bai XJ, Li H, et al. Aortic ageing-related remodeling and analysis on remodeling regularity in the aged rats[J].Chin J Gerontol, 2007, 27(7):612-614. http://www.cnki.com.cn/Article/CJFDTOTAL-ZLXZ200707007.htm [14] Islam SF, Hadiuzzaman KM, Islam MN, et al. Role of protocol biopsy in early graft dysfunction in renal transplant recipient[J]. Mymensingh Med J, 2014, 23(2):286-289. https://www.ncbi.nlm.nih.gov/pubmed/24858156 [15] Verma SK, Molitoris BA.Renal endothelial injury and microvascular dysfunction in acute kidney injury[J]. Semin Nephrol, 2015, 35(1):96-107. doi: 10.1016/j.semnephrol.2015.01.010 [16] Xu HL, Ou C, Rong L, et al. The potential signal pathway between PAX2 and CD2AP in the renal interstitial fibrosis disease[J]. J Recept Signal Transduct Res, 2014, 34(4):290-298. doi: 10.3109/10799893.2013.876045 [17] Zhou TB, Qin YH, Lei FY, et al. Association of prohibitin-1 and 2 with oxidative stress in rats with renal interstitial fibrosis[J]. Mol Biol Rep, 2014, 41(5):3033-3043. doi: 10.1007/s11033-014-3162-1 [18] Long YB, Qin YH, Zhou TB, et al. Association of retinoic acid receptors with extracellular matrix accumulation in rats with renal interstitial fibrosis disease[J]. Int J Mol Sci, 2012, 13(11):14073-14085. http://www.ncbi.nlm.nih.gov/pubmed/23203050 [19] Yevdokimova NY. High glucose-induced alterations of extracellular matrix of human skin fibroblasts are not dependent on TSP-1-TGF beta1 pathway[J]. J Diabetes Complications, 2003, 17(6):355-364. doi: 10.1016/S1056-8727(02)00225-8 [20] Floege J, Johnson RJ, Gordon K, et al. Increased synthesis of extra celluar matrix in mesangial prolifertive mephritis[J]. Kidney Int, 1991, 40(3):477-488. doi: 10.1038/ki.1991.235 [21] Zhou X, Zhang J, Xu C, et al. Curcumin ameliorates renal fibrosis by inhibiting local fibroblast proliferation and extracellular matrix deposition[J]. J Pharmacol Sci, 2014, 126(4):344-350. doi: 10.1254/jphs.14173FP