Boom Henk, Mallat Marko J K, de Fijter Johan W, Paul Leendert C, Bruijn Jan A, van Es Leendert A
Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands.
Transplantation. 2004 Mar 27;77(6):868-73. doi: 10.1097/01.tp.0000116417.03114.87.
Delayed graft function (DGF) occurs in up to 50% of renal transplants. Hypercalcemia and hyperparathyroidism are associated with impaired renal function. Little is known on the effects of serum calcium levels on DGF. This issue was addressed in the current study.
Patients receiving a cadaveric renal transplant between 1986 and 1996 were studied. Data on calcium metabolism and histologic characteristics of nephrocalcinosis, acute tubular necrosis (ATN), and acute rejection in biopsies taken within the first week were related to the occurrence of DGF.
The incidence of DGF in a cohort of 585 cadaveric transplants was 31%. DGF correlated independently with serum calcium levels (odds ratio [OR] 1.14 [95% confidence interval (CI) 1.04-1.26] per 0.1 mmol/L). The use of calcium channel blockers before transplantation protected against DGF (OR 0.5 [95% CI 0.29- 0.87]). In this selected group, we found an association with histologic signs of ATN and DGF. However, most of the biopsies also had features of acute rejection or nephrocalcinosis. Nephrocalcinosis was found in 12 of 71 biopsies and was not associated with serum calcium levels or the occurrence of DGF.
In this study, serum calcium levels were independently associated with DGF. This could not be explained by the presence of microscopic nephrocalcinosis. Therefore, DGF is attributed to high intracellular calcium levels. Because calcium supplementation and vitamin D analogues are commonly used in dialysis practice, hypercalcemia influences long-term graft outcome by its effect on DGF. The pretransplant use of calcium channel blockers has a protective effect on the occurrence of DGF.
高达50%的肾移植会发生移植肾功能延迟恢复（DGF）。高钙血症和甲状旁腺功能亢进与肾功能受损有关。关于血清钙水平对DGF的影响知之甚少。本研究探讨了这一问题。
对1986年至1996年间接受尸体肾移植的患者进行研究。第一周内活检中钙代谢数据以及肾钙质沉着症、急性肾小管坏死（ATN）和急性排斥反应的组织学特征与DGF的发生相关。
在585例尸体肾移植队列中，DGF的发生率为31%。DGF与血清钙水平独立相关（每0.1 mmol/L的比值比[OR]为1.14[95%置信区间（CI）1.04 - 1.26]）。移植前使用钙通道阻滞剂可预防DGF（OR 0.5[95%CI 0.29 - 0.87]）。在这个特定组中，我们发现ATN的组织学征象与DGF有关。然而，大多数活检还具有急性排斥反应或肾钙质沉着症的特征。71例活检中有12例发现肾钙质沉着症，其与血清钙水平或DGF的发生无关。
在本研究中，血清钙水平与DGF独立相关。这不能用显微镜下肾钙质沉着症的存在来解释。因此，DGF归因于细胞内钙水平升高。由于透析实践中常用补钙和维生素D类似物，高钙血症通过其对DGF的影响影响长期移植结局。移植前使用钙通道阻滞剂对DGF的发生有保护作用。
