Peeters Patrick, Vanholder Raymond
Renal Division, Department of Internal Medicine, University Hospital Gent, Belgium.
Transplantation. 2008 Apr 15;85(7 Suppl):S31-7. doi: 10.1097/TP.0b013e318169c548.
Dialyzed delayed graft function (DGF) and nondialyzed slow graft function (SGF) both determine a large portion of the negative impact on patient and graft survival, on early acute rejection incidence, on tubulointerstitial fibrosis/tubular atrophy, and on graft function. In an era where expanded-criteria donors, including older donors, and non-heart beating donors are used to overcome organ shortage, the long-term results of kidney transplantation are influenced by the events occurring within the first 24 hr before and after the transplantation procedure. The ischemia-reperfusion injury is initiated in the brain-death donor and continues during preservation and engraftment of the transplant. The determinants of this DGF/SGF complex intervene in five chronologically related stages--donor tissue quality, brain death and related stress, preservation variables, immune factors, and recipient variables. For each of these five stages, therapeutic interventions or preventive measures are capable of partially reversing the expected dismal outcome of DGF/SGF; these measures are discussed in this article. Donor selection and pharmacologic modulations do have an effect on DGF/SGF.
透析的移植肾功能延迟恢复（DGF）和未透析的移植肾功能缓慢恢复（SGF）均在很大程度上决定了对患者和移植物存活、早期急性排斥反应发生率、肾小管间质纤维化/肾小管萎缩以及移植物功能的负面影响。在一个使用扩大标准供体（包括老年供体）和非心脏跳动供体来克服器官短缺的时代，肾移植的长期结果受到移植手术前后最初24小时内发生的事件的影响。缺血再灌注损伤始于脑死亡供体，并在移植物的保存和植入过程中持续存在。这种DGF/SGF复合体的决定因素涉及五个按时间顺序相关的阶段——供体组织质量、脑死亡及相关应激、保存变量、免疫因素和受体变量。对于这五个阶段中的每一个，治疗干预或预防措施都能够部分逆转DGF/SGF预期的不良结局；本文将讨论这些措施。供体选择和药物调节确实对DGF/SGF有影响。
