Quiroga Isabel, McShane Philip, Koo Dicken D H, Gray Derek, Friend Peter J, Fuggle Susan, Darby Christopher
Nuffield Department of Surgery, John Radcliffe Hospital, Oxford, OX3 7LJ, UK.
Nephrol Dial Transplant. 2006 Jun;21(6):1689-96. doi: 10.1093/ndt/gfl042. Epub 2006 Feb 20.
There is mounting evidence from experimental and clinical studies that the quality of organs from cadaver donors may be influenced by events occurring around the time of brain death, and that these may affect transplant outcome. The aim of this study is to investigate the influence of donor factors on renal allograft outcome in a homogeneous cohort of 518 patients transplanted in a single centre over a 9 year period.
Endpoints of the study were delayed graft function (DGF), acute rejection (AR), 1 year graft survival and long-term survival of those grafts that reached 1 year. Multivariate analysis was performed to determine factors that may have influenced the graft outcome indicators.
DGF was the major predictor of graft failure overall with cold ischaemia time (CIT) as an important independent factor. The level of histocompatibility did not influence graft survival. DGF was the major factor affecting 1 year graft survival (P<0.0005) with effects persisting beyond 1 year. DGF was significantly influenced by CIT, donor age, female kidney into male recipient and donor creatinine (P<0.05). Other donor factors and factors associated with donor management were not risk factors for DGF, rejection episodes or graft survival. The risk factors for a number of AR episodes were HLA-DR mismatch and DGF (P<0.005). When grafts surviving for 1 year were considered, only CIT, recipient age and creatinine at 1 year (P<0.05) were found to affect graft survival significantly.
The results of this analysis of well-matched transplant recipients show that CIT and DGF are the most important predictors of poor short and long-term graft survival. Therefore, in order to improve the long-term survival of renal allografts efforts should focus on limiting CIT and the damage that occurs during this period and on improving our understanding of DGF.
实验研究和临床研究中有越来越多的证据表明，尸体供体器官的质量可能受到脑死亡前后发生事件的影响，且这些事件可能会影响移植结果。本研究旨在调查在一个中心9年期间接受移植的518例同质队列患者中，供体因素对肾移植结果的影响。
研究终点为移植肾功能延迟恢复（DGF）、急性排斥反应（AR）、1年移植肾存活率以及存活达1年的移植肾的长期存活率。进行多变量分析以确定可能影响移植结果指标的因素。
总体而言，DGF是移植失败的主要预测因素，冷缺血时间（CIT）是一个重要的独立因素。组织相容性水平不影响移植肾存活。DGF是影响1年移植肾存活的主要因素（P<0.0005），其影响持续超过1年。DGF受CIT、供体年龄、女性供肾给男性受者以及供体肌酐的显著影响（P<0.05）。其他供体因素以及与供体管理相关的因素不是DGF、排斥反应发作或移植肾存活的危险因素。多次AR发作的危险因素是HLA-DR错配和DGF（P<0.005）。当考虑存活1年的移植肾时，仅发现CIT、受者年龄和1年时的肌酐（P<0.05）对移植肾存活有显著影响。
对配型良好的移植受者的这项分析结果表明，CIT和DGF是短期和长期移植肾存活不佳的最重要预测因素。因此，为了提高肾移植的长期存活率，应努力集中于限制CIT及其期间发生的损伤，并增进我们对DGF的理解。
