BACKGROUND Nephrosclerosis, nephron size, and nephron number vary among kidneys transplanted from living donors. However, whether these structural features predict kidney transplant recipient outcomes is unclear. METHODS Our study used computed tomography (CT) and implantation biopsy to investigate donated kidney features as predictors of death-censored graft failure at three transplant centers participating in the Aging Kidney Anatomy study. We used global glomerulosclerosis, interstitial fibrosis/tubular atrophy, artery luminal stenosis, and arteriolar hyalinosis to measure nephrosclerosis; mean glomerular volume, cortex volume per glomerulus, and mean cross-sectional tubular area to measure nephron size; and calculations from CT cortical volume and glomerular density on biopsy to assess nephron number. We also determined the death-censored risk of graft failure with each structural feature after adjusting for the predictive clinical characteristics of donor and recipient. RESULTS The analysis involved 2293 donor-recipient pairs. Mean recipient follow-up was 6.3 years, during which 287 death-censored graft failures and 424 deaths occurred. Factors that predicted death-censored graft failure independent of both donor and recipient clinical characteristics included interstitial fibrosis/tubular atrophy, larger cortical nephron size (but not nephron number), and smaller medullary volume. In a subset with 12 biopsy section slides, arteriolar hyalinosis also predicted death-censored graft failure. CONCLUSIONS Subclinical nephrosclerosis, larger cortical nephron size, and smaller medullary volume in healthy donors modestly predict death-censored graft failure in the recipient, independent of donor or recipient clinical characteristics. These findings provide insights into a graft's "intrinsic quality" at the time of donation, and further support the use of intraoperative biopsies to identify kidney grafts that are at higher risk for failure.

中文翻译：

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来自活体捐献者的肾脏结构特征可预测接收者的移植失败。

背景技术从活体供体移植的肾脏之间，肾硬化，肾单位大小和肾单位数量有所不同。然而，这些结构特征是否可以预测肾移植受体的结果尚不清楚。方法我们的研究使用计算机断层扫描（CT）和植入活检来调查捐赠的肾脏特征，作为参与肾脏老化解剖研究的三个移植中心进行死亡检查的移植物衰竭预测指标。我们使用了整体性肾小球硬化，间质纤维化/肾小管萎缩，动脉腔狭窄和小动脉透明变性来测量肾硬化。平均肾小球体积，每个肾小球的皮层体积以及测量肾单位大小的平均横截面管状面积；并根据活检的CT皮质体积和肾小球密度进行计算，以评估肾单位数目。在调整供体和受体的预测临床特征后，我们还确定了每种结构特征的以死亡检查的移植失败风险。结果分析涉及2293个供体-受体对。接受者的平均随访时间为6.3年，在此期间，发生了287例以死亡检查为基础的移植失败，发生了424例死亡。可以独立于供体和受体临床特征预测死亡检查的移植失败的因素包括：间质纤维化/肾小管萎缩，皮质肾单位面积较大（但肾单位数量除外）和髓体积较小。在具有12个活检切片的子集中，小动脉透明质酸也可预测以死亡检查的移植失败。结论亚临床性肾硬化，较大的皮质肾单位，健康的捐献者中较小的髓质体积适中地预测了接受捐献者中受死亡检查的移植失败，而与捐献者或接受者的临床特征无关。这些发现提供了对捐赠时移植物“内在质量”的见解，并进一步支持了术中活检以鉴定出失败风险更高的肾移植物。