Utjecaj odgođene funkcije presatka na progresiju kroničnih histoloških promjena u presađenom bubregu

doctoral thesis

• Title (english): The impact of delayed graft function on progression of chronic histological changes in transplanted kidney
• Author: Bojana Maksimović
• Mentor: Mladen Knotek (mentor)
• Committee member: nije dostupno (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2018-12-18, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences
• Universal decimal classification (UDC): 61 - Medical sciences

Abstract

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.

Abstract (english)

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.

• Keywords: medicina
• Keywords (english): medicine
• Language: croatian
• URN:NBN: urn:nbn:hr:105:527446
• Study programme: Title: Biomedicine and Health Sciences; Study programme type: university; Study level: postgraduate; Academic / professional title: doktor/doktorica znanosti, područje biomedicine i zdravstva (doktor/doktorica znanosti, područje biomedicine i zdravstva)
• Type of resource: Text
• Extent: 58 str.
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-05-05 08:14:54