This prospective cohort study evaluates associations between structural and ultrastructural parameters in baseline biopsies from human kidney transplants and long-term graft survival after more than 14 years’ follow-up. Baseline kidney graft biopsies were obtained prospectively from 54 consecutive patients receiving a kidney transplant at a single institution. Quantitative measurements were performed on the baseline biopsies by computer-assisted light microscopy and electron microscopy. Stereology-based techniques estimated the fraction of interstitial tissue, the volume of glomeruli, mesangial fraction, and basement membrane thickness of glomerular capillaries. The fraction of occluded glomeruli and scores according to the Banff classification were achieved. Kidney graft survival was analyzed by Kaplan–Meier estimates and Cox regression. Association to long-term kidney function was also analyzed. The long-term surviving kidney transplants were characterized at implantation by less arteriolar hyaline thickening (P < 0.001) and less interstitial fibrosis (P = 0.001), as well as a lower fraction of occluded glomeruli (P = 0.004) and lower glomerular volume (P = 0.03). At the latest follow-up, eGFR was decreased by 12 ml/min/1.73 m² per unit increase in the score for arteriolar hyalinosis at implantation (P = 0.02), and eGFR was decreased by 19 ml/min/1.73 m² per 10⁶ μm³ increase in glomerular volume at baseline (P = 0.03). The unbiased Cavalieri estimate of glomerular volume and the ultrastructural parameters are the first to be evaluated in a cohort study with prospective follow-up for more than 14 years. The study shows that baseline biopsies from human kidney grafts contain extraordinary long-term prognostic information, and it highlights the importance of these intrinsic graft factors.

这项前瞻性队列研究评估了来自人类肾脏移植的基线活检组织中结构和超微结构参数与14年以上随访后长期移植物存活之间的关系。基线肾脏移植物活检是前瞻性地从一所机构中接受肾脏移植的54位连续患者中获得的。通过计算机辅助光学显微镜和电子显微镜对基线活检进行定量测量。基于体视学的技术估计了间质组织的分数，肾小球的体积，肾小球系膜分数和肾小球毛细血管的基底膜厚度。获得了根据Banff分类的阻塞的肾小球分数和分数。通过Kaplan–Meier估计和Cox回归分析肾脏移植物的存活率。还分析了与长期肾功能的关系。长期存活的肾脏移植的特点是植入时小动脉透明膜增厚较少（P <0.001）和较少的间质纤维化（P = 0.001），以及较低的阻塞性肾小球分数（P = 0.004）和较低的肾小球体积（P = 0.03）。在最新的随访，EGFR被减少12毫升/分钟/1.73米²在植入每单位增加分数小动脉透明变性（P = 0.02），和EGFR降低了19毫升/分钟/1.73米²每10 ⁶微米³在基线增加肾小球体积（P= 0.03）。无偏倚的Cavalieri估计的肾小球体积和超微结构参数是一项在队列研究中进行了首次评估的研究，其随访时间超过14年。该研究表明，从人肾移植物中获得的基线活检标本包含非凡的长期预后信息，并突出了这些固有移植物因素的重要性。